Abstract
A thirty-year-old male was transferred to our emergency department after being injured in an automobile accident. He was conscious at the time of admission. Chest X-ray revealed fracture of the left first rib and a gradually increasing mediastinal shadow, which suggested injury to the subclavian artery. On the day of injury, the patient exhibited right hemiparesis, without any abnormality on head CT scan. There was no laterality or blood flow reduction on SPECT, and no major vessel occlusions were detected with using TCD. Thoracic CT scan revealed fractures of the 4th and 5th thoracic vertebrae, but no spinal cord injuries were found using MRI. Angiography revealed complete occlusion of the left common carotid artery and collateral circulation. His right hemiparesis gradually improved, and MRI revealed no infarcted lesion in the brain. In this case, blunt thoraco-cervical trauma caused fracture of the first rib, which has lead to injury of the carotid artery and jugular vein. These major vessel injuries led to transient hemiparesis and increasing mediastinal bleeding. Carotid artery injury is a rare complication of traumatic head and neck injury, and common carotid injury caused by thoraco-cervical trauma is extremely rare. Angiography is the gold standard for diagnosis of such vessel injuries, and aggressive examination is recommended for such complicated injuries.
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