European Journal of Radiology Extra 63 (2007) 87–88 Traumatic bilateral pseudo-aneurysms of the subclavian arteries Irene Mwangi a,∗ , Calvin Coffey b , Sayed Aly b , John G. Murray a a Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland b Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland Received 12 February 2007; received in revised form 23 April 2007; accepted 30 April 2007 Abstract We report a case of bilateral traumatic pseudo-aneurysms of the subclavian arteries involving the vertebral artery origins. It highlights the importance of a carefully performed CT angiogram of the proximal great vessels of the neck in suspected aortic transection. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Subclavian artery; Pseudo-aneurysm; Vertebral artery 1. Introduction Pseudo-aneurysms of the subclavian arteries usually result from either blunt or penetrating trauma. The trauma is nor- mally secondary to fracture of the first rib or clavicle. Up to 10% of patients with aortic transection due to blunt trauma have an associated aortic branch vessel injury [1]. We report a case of bilateral pseudo-aneurysms of the subclavian arter- ies with transection of the left vertebral artery and bilateral subluxations of the sternoclavicular joints. 2. Case report Following a high-speed motor vehicle accident, a 19-year- old man was referred to a tertiary hospital with a diagnosis of multiple fractures of the odontoid peg, mandible, left femoral head, right acetabulum and a dislocation of the right knee. Chest radiograph showed mediastinal widening and accord- ingly he was referred for CT thorax. This was interpreted as showing a normal aorta with mediastinal widening due to haematoma. Surgery was performed for his femoral fractures and traction was applied for his peg fracture. Post-operatively, ∗ Corresponding author. Tel.: +353 87 694 1304. E-mail addresses: irenewaithis@yahoo.com (I. Mwangi), calvincoffey@hotmail.com (C. Coffey), sayed@doctors.org.uk (S. Aly), jmurray@mater.ie (J.G. Murray). it was noted that he had a left sided arm weakness with absent left radial, ulnar and brachial pulses. Subsequent emergency MR scan of brain showed a post-traumatic non- hemorrhagic shear injury at the grey white matter interface high in the right frontal lobe, and infarcts of the cerebellum suggesting a vertebral dissection. Accordingly, a gadolin- ium enhanced MR arteriogram of the neck arteries was performed. This showed bilateral pseudo-aneurysms of the subclavian arteries involving the vertebral artery origins. The pseudo-aneurysm on the right measured 3.3 cm and arose at the origin of the right vertebral artery. The right verte- bral artery was patent. The left subclavian pseudo-aneurysm measured 3.7 cm and arose just proximal to the origin of the left vertebral artery, which was occluded, suggestive of vertebral artery transection. The distal subclavian arteries were patent bilaterally (Fig. 1). MR arteriogram images of the intracranial circulation demonstrated normal intracranial vasculature. Because, the left vertebral artery was occluded, a covered Vioban stent was inserted via the left brachial artery across the left subclavian pseudo-aneurysm with good result. An open repair of the right subclavian artery pseudo-aneurysm was performed via a median sternotomy. The right vertebral artery was found to have completely separated from its origin and was tied off at its origin. The right subclavian artery was transected and an interposition graft was placed between the origin of the subclavian and the middle third of the axillary artery. 1571-4675/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrex.2007.04.011