LEFT SUBCLAVIAN ARTERY RUPTURE DUE TO BLUNT THORACIC TRAUMA: A CASE REPORT
Abstract
Abstrak. Trauma tumpul toraks memiliki insiden yang sangat tinggi pada populasi dewasa, 20 – 50 % dari kasus dapat mengakibatkan kematian. Cedera pada struktur pembuluh darah dari bagian dada atas, terutama pembuluh darah arteri subklavia kiri, sangat jarang ditemukan dan biasanya disertai dengan “hematotoraks massif”. Observasi ketat dari tanda- tanda vital dan foto toraks serial sangatlah penting. Kami paparkan sebuah kasus jarang dari seorang pasien yang mengalami cedera traumatik arteri subklavia kiri. Tidak ditemukan gambaran klinis dari hematoma di supra klavikula, pulsasi arteri radialis kiri tidak teraba, dan tidak ditemukan pelebaran dari mediastinum pada foto toraks. Tetapi didapatkan hematotoraks massif kiri. Dilakukan posterolateral torakotomi kiri, dijumpai sumber perdarahan dari bagian apex paru kiri, dicurigai terdapatnya robekan dari pembuluh darah arteri subklavia kiri. Tindakan dilanjutkan dengan insisi median sternotomy yang diperluas ke arah supraklavikula kiri, ditemukan rupture total dari arteri subklavia kiri dengan jarak 1,5 cm proksimal dari arkus aorta. Tindakan repair (perbaikan) arteri secara primer (end to end anastomosis) dilakukan dengan hasil baik. (JKS 2017; 2: 105-114)
Kata kunci : Trauma tumpul toraks, hematotoraks massif, cedera arteri subklavia kiri
Abstract. Blunt thoracic trauma highest incidence is in adult, 20% to 50 % of the trauma cause death. Injuries to the vascular structures of the thoracic outlet, especially left subclavian artery, are rare and typically accompanied by massive hemorrhage. Close observation of vital sign and serial chest x-ray are very important. We describe an unusual presentation of a patient who suffered traumatic rupture of left subclavian artery. No clinical presentation of supraclavicular hematoma, unilateral absence of radial artery pulse and mediastinal widening in chest x-ray was found, but there is a massive hemothorax. Left posterolateral thoracotomy was performed, the source of bleeding was found in the apex of the lung, suspected a rupture of the left subclavian artery. The procedure continued with median sternotomy extended to left supraclavicular incision, a rupture was found in the left subclavian artery, 1,5 cm proximal to aortic arch. Primary repair was done with a good result. (JKS 2017; 2: 105-114)
Key Words : Blunt thoracic trauma, massive hemothorax, left subclavian artery rupture
Keywords
References
References
Galan, et all, Blunt chest injuries in 1696 patients, Eur J Cardio-thorax Surg, 1992;6: 284-2871
Wong, et all, Combined Blunt Aortic and Bronchial Injury, Ann Thorax Surg, 2004;78:2157–9
Kahraman, et all, Blunt Thoracic Trauma: Analysis of 1730 Patients, Asian Cardiovasc Thorax Ann 1998;6:308–312
Iyer, et all, Profile of Chest Trauma in a Refferal Hospital; A Five Year Experience, Asian Cardiovasc Thorac Ann 1999;7:124–7
Hayn, et all, Intrathoracic jugular vein avulsion after blunt chest trauma, J Thorax Cardiovasc Surg 2002;123:190-1
Kapetanakis, et all, Traumatic Partial Avulsion of a Single Right Subclavian Artery from the Aortic Arch and Definitive Repair, Ann Thorax Surg, 2006;81:348 –50
Strums, et all, The management of subclavian artery injuries following blunt thoracic trauma, The Annals of Thoracic Surgery, Vol 38, 1984;188-191
Athanasiou, et all, Emergency thoracotomy in the pre-hospital setting: a procedure requiring clarification, European Journal of Cardio-thoracic Surgery 26,2004;377–386
Thomas, et all, Etiopathology and Management Challenges of Blunt Chest Trauma in Nigeria, Asian Cardiovasc Thorax Ann 2009;17:608–11
Balci, et all, Blunt thoracic trauma in children: review of 137 cases, European Journal of Cardio-thoracic Surgery 26, 2004;387–392
Liman, et all, Chest injury due to blunt trauma, European Journal of Cardio-thoracic Surgery 23, 2003; 374–378
Smith, et all, The management of trauma victims in England and Wales: a study by the National Confidential Enquiry into Patient Outcome and Death, European Journal of Cardio-thoracic Surgery 36, 2009; 340—343
Castagna, et all, Blunt injuries to branches of the aortic arch, The Journal of Thoracic and Cardiovascular Surgery, Vol 69, 1975; 521-532
Guyader, et all, Blunt chest trauma: a right pulmonary vein rupture, a case report, European Journal of Cardio-thoracic Surgery 20, 2001;1054–1056
Leashnower, et all, Anterior Approach to Traumatic Mid Aortic Arch Transection, Ann Thorac Surg 2006;81:343–5
Tsui, et all, Combined subclavian artery rupture and delayed bronchial stenosis from blunt chest trauma, Eur J Cardio-thorax Surg, 1991; 610-6121
Cunningham, Subclavian Artery Transection Due to Blunt Trauma, Vascular and Endovascular Surgery Journal, Vol. 18, No. 6, 1984; 386-390
Eslami, et all, Injury to the Thoracic Great Vessel, Thoracic Surgery Secret Text Book, Jaypee Brother’s Publisher, 2001, 238-40
Ipaktchi, et all, Subclavian artery and jugular vein rupture after a blunt thoracic trauma due to a BMX handlebar, European Journal of Cardio-thoracic Surgery 37, 2010; 235
Rubin, et all, Transection of left common carotid artery with arch extension after blunt chest trauma, a case report, Interactive CardioVascular and Thoracic Surgery 3, 2004; 608–611
Veerasingam, et all, Traumatic transection of the innominate artery, a case report, Interactive Cardiovascular and Thoracic Surgery,2, 2003; 569–571
Pate, et all, Acute Traumatic Rupture of the Aortic Isthmus: Repair with Cardio-pulmonary Bypass, Ann Thorax Surg1995; 59:90-98
Jones, et all, Traumatic rupture of the innominate artery, European Journal of Cardio-thoracic Surgery, 23, 2003; 782–787
Weiman, et all, Blunt injuries of the brachiocephalic artery, Am Surgery Journal, 1998;64(5):383-7
DOI: 10.24815/jks.v17i2.8989
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