Aberrant anatomy angel – a near-miss penetrating neck trauma and a life-saving retropharyngeal right subclavian artery

Penetrating neck injuries constitute a relatively rare subset of trauma, which unfortunately carries with it significant morbidity and mortality. In the Emergency Department (ED), rapid clinical decompensation related to haemorrhagic, obstructive or mixed damage to major vessels and airways is typically the primary culprit, which is compounded even further by any intrathoracic involvement. Even rarer, however, is to sustain such an injury with no haemodynamic compromise and follow through with an uneventful clinical course. Here we present a remarkable case of a dirt-bike accident which left a male impaled by a tree branch, and the swift clinical conduct along with the fortuitous variation in his anatomy that saved his life.