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Asian Cardiovasc Thorac Ann 2006;14:85
© 2006 Asia Publishing EXchange Ltd

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 Surgery, Sapporo Medical University School of Medicine Sapporo, Japan

For reprint information contact: Tohru Mawatari, MD Tel: 81 11 611 2111 ext 3312 Fax: 81 11 613 7318 Email: mawatari{at}sapmed.ac.jp, Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8556, Japan

A 21-year-old man with traumatic dislocated fracture of the sternum, first rib and clavicle due to a traffic 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 1Go). 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-fixed by non-absorbable sutures. The postoperative enhanced CT showed that the stenosis of SVC improved (Figure 2Go).


Figure 1
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  		Figure 1. Preoperative CT: The SVC was depressed by the proximal side of the clavicle.

 

Figure 2
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  		Figure 2. Postoperative CT: The stenosis of the SVC improved and the inflow from a left brachiocephalic vein to SVC was smooth.

 





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Tomio Abe
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