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Cervicothoracic screwdriver impalement causing traumatic aortic injury managed with TEVAR.
Malena Allbright1, Divya Mohanraj2, Sheetal Bapu2
1Albany Medical College, Albany, New York, USA allbrim@amc.edu.
BMJ Case Reports
|July 1, 2026
Summary
A rare penetrating neck injury involving a screwdriver impaled to the thoracic inlet was successfully managed. This case highlights the critical role of early airway control and endovascular repair in treating complex aortic arch pseudoaneurysms.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Emergency Medicine
Background:
- Penetrating neck injuries are infrequent but associated with high mortality.
- The proximity of vital structures in the neck increases the risk of severe complications.
Purpose of the Study:
- To report a unique case of a large penetrating neck injury.
- To describe the successful multidisciplinary management of a thoracic aortic arch pseudoaneurysm secondary to impalement.
Main Methods:
- A case report of an elderly female with a 40-cm screwdriver impaled in the neck.
- Computed tomographic angiography (CTA) for diagnosis of pseudoaneurysm and hemorrhage.
- Emergent tracheostomy in a hybrid operating room.
- Thoracic endovascular aortic repair (TEVAR) for hemorrhage control.
- Delayed screwdriver removal under controlled conditions.
Main Results:
- The patient presented with a distal thoracic aortic arch pseudoaneurysm and mediastinal hemorrhage.
- Initial hemodynamic stability was followed by airway compromise requiring emergent tracheostomy.
- TEVAR successfully excluded the pseudoaneurysm and controlled bleeding.
- The patient was discharged on postoperative day 19 with no major complications.
Conclusions:
- Multidisciplinary care in a hybrid operating room is crucial for managing complex penetrating neck injuries.
- Early airway management and endovascular hemorrhage control are vital for patient survival.
- This case underscores the feasibility of a staged approach involving endovascular repair prior to foreign body removal.
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