Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jul 4;16(7):e253826.
doi: 10.1136/bcr-2022-253826.

Ruptured subclavian artery pseudoaneurysm following a shoulder massage on a background of clavicle non-union

Jason Lawson  1 , Stephen Crockett  1 , Dylan Griffiths  2 , Celia Riga  1 , Sanjeeve Sabharwal  2 , Robert Thomas  3 , Rishi Das  4   5
Affiliations
Case Reports

Ruptured subclavian artery pseudoaneurysm following a shoulder massage on a background of clavicle non-union

Jason Lawson et al. BMJ Case Rep. .

Abstract

We present an unusual case of ruptured subclavian artery pseudoaneurysm following hydrotherapy and shoulder massage session on a background of clavicle non-union.Following a clavicle fracture 16 years ago, which was managed conservatively, a woman in her 30s presents over a decade later with a ruptured subclavian artery pseudoaneurysm.The original midshaft clavicle fracture was sustained 16 years ago. Conservative management was agreed, and she was discharged. Six years ago, she developed a small subclavian artery pseudoaneurysm which was kept under surveillance for 12 months with no active intervention required.Over the following years, she continued to have intermittent shoulder girdle discomfort and neuropathic symptoms. On this presentation, after a sports massage, she presented with rapid-onset supraclavicular and axillary swelling. This was diagnosed as a ruptured subclavian artery pseudoaneurysm and was treated with emergency radiological-guided stenting and subsequent internal fixation of the clavicle non-union.The patient then attended regular orthopaedic and vascular follow-up to ensure her clavicle fracture unites and the graft remains patent.We discuss the case presentation and management of this unusual injury.

Keywords: interventional radiology; orthopaedic and trauma surgery; vascular surgery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Initial CT angiogram at discussion 6 years ago demonstrating a small 4 mm pseudoaneurysm. (B) CT angiogram check at 1 year demonstrating no increase in size of the pseudoaneurysm.
Figure 2
Figure 2
CT angiogram at presentation following onset of symptoms, confirming an infraclavicular area of contrast extravasation and an associated haematoma.
Figure 3
Figure 3
(A) Angiogram via left brachial artery demonstrating pseudoaneurysm within distal brachial artery at the level of the old fracture. (B) Single acquisition of a balloon mounted 8 mm stent graft (BeGraft; Bentley Medical) with nominal pressure positioned at the level of the pseudoaneurysm. (C, D) Angiogram post-stenting demonstrating satisfactory stent graft position covering the neck of the pseudoaneurysm with technical success and no filling of the pseudoaneurysm.
Figure 4
Figure 4
Plain film radiograph demonstrating established non-union.
Figure 5
Figure 5
(A, B) Intraoperative photos of the clavicle fixation.
Figure 6
Figure 6
Intraoperative fluoroscopy confirming position of plate and screws.
Figure 7
Figure 7
Radiograph 4 months postoperatively demonstrating fracture union.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bravo CJ, Wright CA. Displaced, comminuted diaphyseal clavicle fracture. J Hand Surg Am 2009;34:1883–5. 10.1016/j.jhsa.2009.10.012 - DOI - PubMed
    1. Ahrens PM, Garlick NI, Barber J, et al. The clavicle trial: a multicenter randomized controlled trial comparing operative with nonoperative treatment of displaced midshaft clavicle fractures. J Bone Joint Surg Am 2017;99:1345–54. 10.2106/JBJS.16.01112 - DOI - PubMed
    1. Nicholson JA, Clement ND, Clelland AD, et al. Displaced midshaft clavicle fracture union can be accurately predicted with a delayed assessment at 6 weeks following injury: a prospective cohort study. J Bone Joint Surg Am 2020;102:557–66. 10.2106/JBJS.19.00955 - DOI - PubMed
    1. Wang Y, Dong X, Liang H, et al. Endovascular treatment of Subclavian artery Pseudoaneurysm. Ann Vasc Surg 2020;65:284. 10.1016/j.avsg.2019.10.096 - DOI - PubMed
    1. Quinones-Baldrich WJ. Right subclavian pseudoaneurysm secondary to blunt trauma in an arteriovenous malformation. J Vasc Surg 2010;51:228–9. 10.1016/j.jvs.2009.03.010 - DOI - PubMed

Publication types