Cargando…

Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report

INTRODUCTION: Axillary artery injury in the shoulder region following blunt trauma without association with either shoulder dislocation or fracture of the humeral neck has been previously reported. Axillary artery injury might also be accompanied with brachial plexus injury. However, delayed onset o...

Descripción completa

Detalles Bibliográficos
Autores principales: Murata, Keiichi, Maeda, Manabu, Yoshida, Atsushi, Yajima, Hiroshi, Okuchi, Kazuo
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2329636/
https://www.ncbi.nlm.nih.gov/pubmed/18373866
http://dx.doi.org/10.1186/1749-7221-3-9
_version_ 1782152751090761728
author Murata, Keiichi
Maeda, Manabu
Yoshida, Atsushi
Yajima, Hiroshi
Okuchi, Kazuo
author_facet Murata, Keiichi
Maeda, Manabu
Yoshida, Atsushi
Yajima, Hiroshi
Okuchi, Kazuo
author_sort Murata, Keiichi
collection PubMed
description INTRODUCTION: Axillary artery injury in the shoulder region following blunt trauma without association with either shoulder dislocation or fracture of the humeral neck has been previously reported. Axillary artery injury might also be accompanied with brachial plexus injury. However, delayed onset of brachial plexus palsy caused by a compressive hematoma associated with axillary injury after blunt trauma in the shoulder region has been rarely reported. In previous reports, this condition only occurred in old patients with sclerotic vessels. We present a case of a young patient who suffered axillary artery injury associated with brachial plexus palsy that occurred tardily due to compressive hematoma after blunt trauma in the shoulder region without association of either shoulder dislocation or humeral neck fracture. CASE PRESENTATION: A 16-year-old male injured his right shoulder in a motorbike accident. On initial physical evaluation, the pulses on the radial and ulnar arteries in the affected arm were palpable. Paralysis developed later from 2 days after the injury. Functions in the right arm became significantly impaired. Angiography showed complete occlusion of the axillary artery. Magnetic resonance imaging demonstrated a mass measuring 4 × 5 cm that was suspected to be a hematoma compressing the brachial plexus in a space between the subscapular muscle and the pectoralis minor muscle. Surgery was performed on the third day after injury. In intraoperative observations, the axillary artery was occluded with thrombus along 5 cm; a subscapular artery was ruptured; the brachial plexus was compressed by the hematoma. After evacuation of the hematoma, neurolysis of the brachial plexus, and revascularization of the axillary artery, the patient had an excellent functional recovery of the affected upper limb, postoperatively. CONCLUSION: Surgeons should be aware that axillary artery injuries may even occur in young people after severe blunt trauma in the shoulder region and can be associated with secondary brachial plexus injury due to a hematoma. For treatment in cases with progressive nervous deficit after trauma, not only reconstruction of the injured artery but also immediate evacuation of the hematoma, and exploration of the brachial plexus are necessary to avoid irreversible neurological damage.
format Text
id pubmed-2329636
institution National Center for Biotechnology Information
language English
publishDate 2008
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-23296362008-04-23 Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report Murata, Keiichi Maeda, Manabu Yoshida, Atsushi Yajima, Hiroshi Okuchi, Kazuo J Brachial Plex Peripher Nerve Inj Case Report INTRODUCTION: Axillary artery injury in the shoulder region following blunt trauma without association with either shoulder dislocation or fracture of the humeral neck has been previously reported. Axillary artery injury might also be accompanied with brachial plexus injury. However, delayed onset of brachial plexus palsy caused by a compressive hematoma associated with axillary injury after blunt trauma in the shoulder region has been rarely reported. In previous reports, this condition only occurred in old patients with sclerotic vessels. We present a case of a young patient who suffered axillary artery injury associated with brachial plexus palsy that occurred tardily due to compressive hematoma after blunt trauma in the shoulder region without association of either shoulder dislocation or humeral neck fracture. CASE PRESENTATION: A 16-year-old male injured his right shoulder in a motorbike accident. On initial physical evaluation, the pulses on the radial and ulnar arteries in the affected arm were palpable. Paralysis developed later from 2 days after the injury. Functions in the right arm became significantly impaired. Angiography showed complete occlusion of the axillary artery. Magnetic resonance imaging demonstrated a mass measuring 4 × 5 cm that was suspected to be a hematoma compressing the brachial plexus in a space between the subscapular muscle and the pectoralis minor muscle. Surgery was performed on the third day after injury. In intraoperative observations, the axillary artery was occluded with thrombus along 5 cm; a subscapular artery was ruptured; the brachial plexus was compressed by the hematoma. After evacuation of the hematoma, neurolysis of the brachial plexus, and revascularization of the axillary artery, the patient had an excellent functional recovery of the affected upper limb, postoperatively. CONCLUSION: Surgeons should be aware that axillary artery injuries may even occur in young people after severe blunt trauma in the shoulder region and can be associated with secondary brachial plexus injury due to a hematoma. For treatment in cases with progressive nervous deficit after trauma, not only reconstruction of the injured artery but also immediate evacuation of the hematoma, and exploration of the brachial plexus are necessary to avoid irreversible neurological damage. BioMed Central 2008-03-28 /pmc/articles/PMC2329636/ /pubmed/18373866 http://dx.doi.org/10.1186/1749-7221-3-9 Text en Copyright © 2008 Murata et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Murata, Keiichi
Maeda, Manabu
Yoshida, Atsushi
Yajima, Hiroshi
Okuchi, Kazuo
Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report
title Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report
title_full Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report
title_fullStr Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report
title_full_unstemmed Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report
title_short Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report
title_sort axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2329636/
https://www.ncbi.nlm.nih.gov/pubmed/18373866
http://dx.doi.org/10.1186/1749-7221-3-9
work_keys_str_mv AT muratakeiichi axillaryarteryinjurycombinedwithdelayedbrachialplexuspalsyduetocompressivehematomainayoungpatientacasereport
AT maedamanabu axillaryarteryinjurycombinedwithdelayedbrachialplexuspalsyduetocompressivehematomainayoungpatientacasereport
AT yoshidaatsushi axillaryarteryinjurycombinedwithdelayedbrachialplexuspalsyduetocompressivehematomainayoungpatientacasereport
AT yajimahiroshi axillaryarteryinjurycombinedwithdelayedbrachialplexuspalsyduetocompressivehematomainayoungpatientacasereport
AT okuchikazuo axillaryarteryinjurycombinedwithdelayedbrachialplexuspalsyduetocompressivehematomainayoungpatientacasereport