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Obstructive shock induced by internal thoracic artery injury with traumatic sternal fracture

Halleluyah Konno¹, Masakazu Nitta¹, Norihiro Watanabe¹

¹Department of Emergency Medicine, Tsubame Rosai Hospital, Niigata, Japan.

Turkish Journal of Emergency Medicine

|August 7, 2024

Abstract:

Internal thoracic artery (ITA) injuries associated with sternal fractures can lead to shock. Several studies have documented injuries resulting in hemorrhagic shock, yet there is limited reporting on obstructive shock. Opinions differ regarding which is superior between transcatheter arterial embolization (TAE) and open thoracotomy. We report the case of an 80-year-old female patient presented with blunt chest trauma when driving. Her vital signs were normal. However, ultrasonography revealed a hypoechoic anterior mediastinal lesion. Her blood pressure decreased immediately before undergoing a computed tomography (CT) scan. The CT scan showed a sternal fracture, anterior mediastinal extravasation, and dilation of the inferior vena cava. TAE was performed on both internal thoracic arteries, and the patient was transferred to a hospital where an open thoracotomy could be performed. The patient was treated conservatively and discharged without sequelae. Obstructive shock caused by an ITA injury with a sternal fracture can be successfully treated using TAE.

Keywords:

Internal mammary artery injury mediastinal hematoma sternum fractures traffic accident

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