Delayed Pseudoaneurysm of the Subclavian Artery Following Clavicle Fracture Fixation: A Case Report

The clavicle is one of the most commonly fractured bones, and may benefit from operative fixation to restore alignment and function. Although rare, vascular complications are a known risk due to the clavicle's anatomical proximity to the subclavian vessels. A delayed subclavian artery pseudoaneurysm is a very uncommon but potentially life-threatening complication that surgeons must be aware of, as recognition may be challenging.

A 17-year-old female sustained a displaced midshaft clavicle fracture while playing ice hockey and was treated with an open reduction and internal fixation. The fracture healed uneventfully, and the patient returned to full athletic activity. However, nearly 7 years later, the patient presented back with a painless right supraclavicular mass that was initially suspected to be lymphadenopathy caused by Hodgkin's lymphoma. During the subsequent open biopsy, brisk arterial bleeding revealed a pseudoaneurysm of the right subclavian artery. The lesion was repaired intraoperatively, and the patient recovered without neurologic deficit or further vascular complications. Follow-up vascular imaging demonstrated a thrombosed pseudoaneurysm without evidence of ongoing arterial flow; therefore, no further intervention was sought.

A delayed subclavian artery pseudoaneurysm can present several years after a clavicle fracture fixation, even in the absence of radiographic risk factors. Persistent or growing supraclavicular masses, vascular concerns, or exertional neurologic symptoms in patients with prior clavicle injury should prompt vascular evaluation.