An unusual shoulder injury

A Rare Case of Neglected Rupture of Right Axillary Artery Pseudoaneurysm Mimicking a Soft Tissue Tumor

Traumatic lesions of the axillary artery itself are limited to 2.9-9% of major arterial injuries. Pseudoaneurysms represent a pulsating encapsulated hematoma in communication with the lumen of a ruptured vessel. Traumatic pseudoaneurysm of the axillary artery is a rare sequela of injury to the shoulder region. We describe a case of posttraumatic pseudoaneurysm involving the axillary artery, which was initially misdiagnosed as an aggressive soft tissue tumor. The man presented 10 years after an injury from a fall from a tree with a slowly growing mass in the right upper limb region and reduced range of movement. This is a neglected case with a history of traditional massage. The patient presented a pathologic fracture of the right proximal humerus and dislocation of the glenohumeral joint. At the beginning, it was suggested to be a primary soft tissue tumor, but after several examinations, including comparable X-ray, ultrasound, and histopathology, the results did not support a soft tissue tumor. Magnetic resonance imaging and computed tomography angiography (CTA) finally confirmed the finding of a pseudoaneurysm of the right axillary artery associated with a huge hematoma with different age of the bleeding product and granulation tissue. This case demonstrates the necessity of early diagnosis of axillary artery pseudoaneurysm to prevent complications after a history of trauma. CTA is a useful modality to evaluate vascular injury and provides valuable information.

An unusual presentation of traumatic pseudoaneurysm of axillary artery mimicking soft tissue tumor

Traumatic pseudoaneurysm of the axillary artery is a rare sequela of injury to shoulder region. We report here a unique case of delayed presentation of axillary artery pseudoaneurysm after a blunt injury, clinically mimicking soft tissue tumor without evidence of gross bony injury. The gentleman presented after six months of injury with a progressively growing mass in left axillary region and neurological deficit. Ultimate management of the lesion was surgical resection and Saphenous vein graft interpositioning. Unfortunately the lack of subsequent neurological recovery parallels some of the findings in the literature, from cases where decompression of the brachial plexus was not undertaken soon enough.