Aneurysm of the thyrocervical trunk after blunt cervical injury

Abstract

A healthy, 22-year-old male blacksmith was admitted to the emergency department with a 5-cm-long wound in the right supraclavicular region, having been stuck by a piece of iron weighing I.1 kg. He had paraesthesiae of the inner border of the arm including the three ulnar fingers. The radial and carotid pulses were intact. There was no history of loss of consciousness. X-rays of the shoulder and right clavicle did not reveal a fracture. The wound was cleaned and sutured, and the patient was discharged from hospital after 2 days. There was no follow-up. Four months later he was referred to the orthopaedic department with persistent pain and reduction of movement of the right shoulder and neck. A torticollis towards the right was noted with accompanying reduction of movement of the neck and right shoulder and there were still paraesthesiae in the three ulnar fingers. No other neurological deficits were encountered and physiotherapy was initiated. Five months after the trauma, he developed a right Homer’s syndrome and a facial palsy. MR-scans of the cervical column and right brachial plexus were normal, but angiography of the brachiocephalic trunk revealed an aneurysm of the right thyrocervical trunk near its origin, extending for 2 cm (Fi,r~lrr, 1). Resection of the aneurysm was performed and the Horner’s syndrome gradually subsided over the following 7 days, but the facial palsy and the ulnar pararsthesiae persisted. Discussion