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Resident PGY 5
Henry Ford Hospital
In this case, a patient presented in a delayed fashion after blunt trauma. He was found to have a large left-sided pneumothorax without any associated traumatic injuries, such as rib fractures. A tube thoracostomy was performed. After placement of the apically-oriented tube, he developed a hemothorax. Computed tomography imaging showed an area of questionable extravasation from the left subclavian artery, directly anterior to the thoracostomy tube. His hemothorax was refractory to adequate drainage with a new thoracostomy tube. He ultimately required angiography, coil embolization, and covered stent placement, followed by thoracoscopic evacuation of the hemothorax. This case is unique because it is a rare occurrence of an early arterial injury to a branch of the subclavian artery, likely secondary to tube thoracostomy. It also highlights the multiple variables required to establish the correct diagnosis, subtle but important imaging findings, and important principles of tube thoracostomy placement.
Mohamed, Adhnan; Leonard-Murali, Shravan; Woodward, Ann; and Blyden, Dione, "Thoracoacromial Artery Injury After Tube Thoracostomy for Pneumothorax" (2020). Case Reports. 47.