TYPE: Case Report TOPIC: Cardiothoracic Surgery INTRODUCTION: Spontaneous subclavian artery dissection (SSAD) is rare. Often it is associated with a history of trauma or catheterisation. We are presenting an asymptomatic case of SSAD and its clinical significance. CASE PRESENTATION: 78 year old female with history of COPD, peripheral arterial disease presented after a mechanical fall. Initial workup showed a left hip fracture on x-ray. Patient underwent surgical repair, during the postoperative period, she experienced shortness of breath requiring additional oxygen. Computed tomography (CT) chest with contrast was negative for pulmonary embolism but noted to have left subclavian artery dissection involving the short segment before the origin of vertebral artery and small pleural effusions. Shortness of breath improved with diuretics. Vascular surgery recommended to manage conservatively as she didn’t have symptoms of stroke, MI, limb ischemia. She was discharged to a rehabilitation facility and remained asymptomatic after one month follow up. DISCUSSION: In our case, there is no neck or chest injury with fall. No history of hypertension or catheterization procedures. CT chest didn’t show any tortuous anatomy. It was an incidental finding with no symptoms. Uncontrolled hypertension, location of subclavian artery below clavicles can increase the risk for dissection apart from traumatic or iatrogenic catheterisation. Other presentations could be stroke, neck pain with cervical disk problems ; non ST segment elevation myocardial infarction or limb ischemia. CONCLUSIONS: If asymptomatic, SSAD can be managed conservatively, but in symptomatic cases causing acute limb ischemia or acute coronary syndrome or stroke they could potentially benefit from early surgical endovascular repair decreasing morbidity and mortality. DISCLOSURE: Nothing to declare. KEYWORD: subclavian artery dissection