Journal
CUREUS JOURNAL OF MEDICAL SCIENCE
Volume 14, Issue 2, Pages -Publisher
CUREUS INC
DOI: 10.7759/cureus.22457
Keywords
vascular injury; spinal cord injury; upper extremity trauma; subclavian pseudoaneurysm; brachial plexus injury
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Early diagnosis of brachial plexus injuries is crucial to prevent long-term morbidity and improve outcomes. This case report highlights a unique case of delayed onset of brachial plexus compression following a traumatic gunshot injury. The patient experienced significant pain and progressive neurological changes during follow-up visits, leading to the discovery of a left subclavian artery pseudoaneurysm. Management through operative intervention was successful.
Early diagnosis of brachial plexus injuries is crucial to prevent long-term morbidity and improve outcomes. We present a unique case of delayed onset of brachial plexus compression two months following a traumatic gunshot injury causing multiple injuries including a T1 vertebral body comminuted fracture and pneumothorax. The patient experienced significant pain and progressive neurological examination changes during follow-up visits, and thus duplex ultrasound and computed tomography (CT) angiography were performed, which demonstrated a left subclavian artery pseudoaneurysm. This was managed operatively by evacuation and interposition bypass. Injuries to the cervical and upper thoracic spine are complex, and when patients present with new-onset neurological findings, axillary swelling, or significant uncontrolled postoperative pain, secondary complications should be suspected. Patients at a high risk of vascular reinjury should be routinely monitored at follow-up to prevent the development of progressive neurological damage to the brachial plexus.
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