CHEST Guidelines-A-54-Year-Old-Man-With-Neck-Swelling,-Respiratory-

A-54-Year-Old-Man-With-Neck-Swelling,-Respiratory-

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A 54-year-old man with chronic kidney disease presented with rapidly enlarging neck swelling, respiratory distress, and hoarseness. The physical examination showed right-sided neck swelling pushing the trachea leftward, and an inspiratory stridor was noted. Previously, the patient underwent right internal jugular vein cannulation for dialysis, which likely led to the symptoms.<br /><br />An ultrasound revealed a pseudoaneurysm in the right subclavian artery, indicated by an anechoic lesion with a 2-mm neck defect and bidirectional blood flow—a yin-yang sign. The pseudoaneurysm was potentially caused by inadvertent puncture during catheter placement. A CT angiography confirmed the pseudoaneurysm and showed compression of the upper trachea and vascular structures.<br /><br />Treatment involved selective subclavian angiography and endovascular balloon occlusion of the right subclavian artery, followed by percutaneous cyanoacrylate injection into the pseudoaneurysm to prevent blood flow. This procedure led to the immediate regression of neck swelling and significant relief of respiratory distress and hoarseness.<br /><br />Pseudoaneurysms result from arterial wall injury, with blood collecting in a cavity bound by fibrin and thrombus. They can lead to serious complications like hemorrhage or vascular compression. Diagnosis is typically made using ultrasound, color Doppler, and spectral Doppler imaging. Treatment options include surgical repair, thrombin injection, or endovascular approaches, with risks varying due to proximity to crucial structures.<br /><br />This case highlights the efficacy of cyanoacrylate glue in treating subclavian pseudoaneurysms. It also underscores the importance of careful technique during central venous catheterizations to prevent such complications. No financial or other conflicts of interest were reported by the authors.

Keywords

chronic kidney disease

neck swelling

pseudoaneurysm

subclavian artery

endovascular treatment

cyanoacrylate injection

vascular compression

catheterization complications

ultrasound diagnosis

respiratory distress