Post-traumatic Thyrocervical Trunk Aneurysm following a Motor Vehicle Accident Repaired Via Endovascular Coil Embolization
Matthew Carnevale, John Phair, MD, Saadat Shariff, MD.
Montefiore Medical Center, Bronx, NY, USA.
Introduction:Aneurysms of the thyrocervical trunk and its branches are rare complications of iatrogenic injury or vascular trauma. Clinical symptoms consistent with thyrocervical trunk aneurysms include a pulsatile mass which can cause mass effect on adjacent structures.
Methods: We performed an extensive literature search using the PubMed database as well as a query of vascular and radiology related journals and were unable to find more than a few cases of thyrocervical trunk aneurysms secondary to trauma. Furthermore, the majority of these post-traumatic thyrocervical aneurysms were secondary to iatrogenic injury. The following search terms were used: “thyrocervical trunk aneurysm”, “coil embolization”, “thyrocervical trunk true aneurysm” and “endovascular peripheral aneurysm repair”.
Case Report: A 63-year-old-male with a history of prostate cancer, seizure disorder, hypertension, hyperlipidemia, and degenerative cervical disk disease presented to his PCP with an acute complaint of right upper extremity pain and weakness associated with loss of balance and light-headedness. The patient previously was in a motor vehicle accident and suffered injury to his right shoulder. Imaging studies included a CT of his neck which showed a 2.6 cm heterogeneous mass in the right paraspinal soft tissues just lateral to the levator scapula muscle at the level C4-C5. His brachial artery was accessed with a micropuncture needle and a catheter was placed near the subclavian artery. The thyrocervical trunk was then cannulated and three coils were placed into the aneurysm. Subsequent angiogram showed very faint filling of the aneurysm.
Discussion: This case represents the second case of a traumatic thyrocervical trunk aneurysm successfully treated via coil embolization. Prompt treatment of peripheral aneurysms, especially those of the thyrocervical trunk is generally recommended because of their likelihood to produce symptoms and complications, particularly thromboembolism. This condition can effectively be treated via open surgical resection or by a minimally invasive approach with endovascular coil.
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