Department of Emergency Medicine, University of Virginia, Charlottesville, USA.
Ann Emerg Med. 2013 Feb;61(2):204-6. doi: 10.1016/j.annemergmed.2012.05.037. Epub 2012 Jul 2.
Clavicle fractures are common; however, complications are unusual. Two such complications, subclavian artery pseudoaneurysm and brachial plexopathy, are rare events that can cause significant morbidity and mortality. We report the case of a 53-year-old man who presented with shoulder swelling and right arm weakness for 1 week. Three weeks before, he had fallen and fractured his right clavicle. On presentation to our emergency department, his examination revealed a brachial plexopathy and a large supraclavicular mass. An emergency bedside triplex sonogram was performed to characterize the mass and revealed a swirling pattern within a fluid collection anterior to the subclavian artery, suggestive of a pseudoaneurysm. After computed tomography-angiography, the patient was taken to the operating room, where he underwent hematoma washout and subclavian artery stent-graft placement. This case illustrates how bedside point-of-care sonography can rapidly assist in the initial assessment of subclavian artery injury.
锁骨骨折很常见,但并发症并不常见。两种这样的并发症,即锁骨下动脉假性动脉瘤和臂丛神经病,是罕见的事件,可导致显著的发病率和死亡率。我们报告了一例 53 岁男性,他因肩部肿胀和右臂无力 1 周就诊。3 周前,他摔倒导致右侧锁骨骨折。在我们的急诊科就诊时,他的检查显示臂丛神经病和锁骨上大肿块。床边紧急三联超声检查用于对肿块进行特征描述,显示在锁骨下动脉前方的积液中有漩涡状图案,提示假性动脉瘤。在计算机断层血管造影后,患者被送往手术室,在那里他接受了血肿冲洗和锁骨下动脉支架置入术。本例说明了床边即时护理超声检查如何快速协助锁骨下动脉损伤的初步评估。