A 33 year-old man was admitted with chief complaints of severe sharp pain on left upper interscapular region and motor weakness of left arm for 9 days. He had a history of blunt trauma over left shoulder about 3 years ago. Physical examination showed a ping pong ball sized mass which was located at the left supraclaviculararea and was firm, fixed, and nonpulsatile. No bruit or murmur was obtained over the mass. Ipsilaterally, radial, ulnar, and brachial pulse were very weak and ptosis and anhydrosis were noticed.
Neurologic examination revealed moderate or severe weakness of flexion and extension of left elbow, wrist and fingers, and. anesthesia of the skin in left C8-Ti dermatome and hypalgesia in left C6-C7 dermatome.
Retrograde aortography demonstrated complete obstruction of left subclavian artery
An exploratory operation was performed through the left 4th intercostal space. It was found that the mass was a left subclavian aneurysm of traumatic false type. Proximal ana distal ligation of the aneurysm were applied and the sac was partially removed. The continuity of the subclavain artery was established by the use of a 6mm. Dacron graft from the root of the subclavian to the axillary artery. Postoperatively the patient was improved from the circulatory and neurologic disturbances.
|