The clinical diagnosis of ruptured subclavian artery following blunt thoracic trauma.

The clinical findings of nine patients who suffered disruption of the subclavian artery following blunt thoracic trauma were reviewed. Seven patients were men, two were women. Their ages ranged from 16 to 43 years. Five patients presented with shock at the time of admission. Five patients incurred a first rib fracture. The radial pulse was present in three patients, absent in three patients, and indeterminant in three patients due to their profound state of shock. Brachial plexus palsy was present in three patients. A palpable supraclavicular hematoma was present in two patients. The chest roentgenograms showed a localized hematoma over the area of the injured subclavian artery in two instances, a widened superior mediastinal shadow in one case, and both findings in another patient. Thus four of the seven patients who survived to undergo chest roentgenograms had films that suggested injury to the arch of the aorta or its branches. Seven patients survived long enough to undergo operative repair; one of these patients died (14%). The following five criteria should alert the physician to the possibility of subclavian arterial injury following blunt thoracic trauma: 1) fractured first rib; 2) diminished or absent radial pulse; 3) palpable supraclavicular hematoma; 4) chest film evidence of hematoma over the area of the subclavian artery or a widened superior mediastinum; and 5) brachial plexus palsy.