A rare cause of occlusion of the brachiocephalic trunk, resulting in fatal stroke: Arterial thoracic outlet syndrome

doi:N/A

eISSN: None / ISSN: None

Netharland Journal of Critical Care

2011, Volume 15, Issue 4 : 204-208

Article

A rare cause of occlusion of the brachiocephalic trunk, resulting in fatal stroke: Arterial thoracic outlet syndrome

Heidt J.

de Beer L.

Admiraal G.C.

Department of Intensive Care, Leiden University Medical Center, Leiden, Netherlands

Department of Radiology, Medical Centre Haaglanden, Hague, Netherlands

Department of Intensive Care, Medical Centre Haaglanden, Hague, Netherlands

Abstract

A 48-year old woman was admitted to the intensive care unit with cardiopulmonary failure secondary to a stroke. Computed tomographic angiography showed a complete occlusion of the brachiocephalic trunk (innominate artery). We found bilateral cervical ribs, with anterior dislocation of the subclavian arteries, causing narrowing of the vessel lumen and distal aneurysmal dilatation due to compression by the anterior scalene muscles. The patient died the following day, despite mechanical ventilation and haemodynamic support. We concluded that she had suffered from arterial thoracic outlet syndrome due to bilateral cervical ribs. We presume that the compression caused stenosis of the subclavian arteries and ultimately resulted in a fatal stroke due to the rare complication of retrograde thromboembolic occlusion of the brachiocephalic trunk. Copyright © 2011, Nederlandse Vereniging voor Intensive Care.

Keywords

Arterial thoracic outlet syndrome

Brachiocephalic trunk

Innominate artery

Occlusion

Stroke

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