traumatic dislocated clavicle fracture with the oppression of superior vena cava
TRANSCRIPT
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY
Traumatic Dislocated Clavicle Fracture with the Oppression of Superior Vena Cava Tohru Mawatari, MD, Atsushi Watanabe, MD, Ryo Harada, MD, Tetsuya Koyanagi, MD, Tomio Abe, MD
Department of Thoracic and Cardiovascular SurgerySapporo Medical University School of MedicineSapporo, Japan
For reprint information contact:Tohru Mawatari, MD Tel: 81 11 611 2111 ext 3312 Fax: 81 11 613 7318 Email: [email protected] of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8556, Japan
Figure 2. Postoperative CT: The stenosis of the SVC improved and the infl ow from a left brachiocephalic vein to SVC was smooth.
A 21-year-old man with traumatic dislocated fracture of the sternum, fi rst rib and clavicle due to a traffi c accident was admitted to our hospital. Although his symptoms did not indicate superior vena cava (SVC) syndrome, computed tomography (CT) showed stenosis of SVC due to a depression caused by posterior dislocation (Figure 1). An operation was performed to repair the dislocation and depression. Midline sternotomy was made, and the adhesion between bone and SVC were dissected following taping of a proximal SVC, bilateral brachiocephalic veins and an azygos vein. The dislocated portion consisting of the sternum, clavicle, and first rib, which pressed the SVC, was resected, and the three bones were re-fi xed by non-absorbable sutures. The postoperative enhanced CT showed that the stenosis of SVC improved (Figure 2).
(Asian Cardiovasc Thorac Ann 2006;14:85)
Figure 1. Preoperative CT: The SVC was depressed by the proximal side of the clavicle.
2006, VOL. 14, NO. 1 85 ASIAN CARDIOVASCULAR & THORACIC ANNALS