CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 9, October 2012
e4
AFRICA
Case Report
Giant pseudoaneurysm of the left axillary artery
following a stab wound
M FOKOU, VC EYENGA, A CHICHOM MEFIRE, ML GUIFO, JJ PAGBE, W SANDMANN
Abstract
Axillary artery pseudoaneurysms are rare. We report on a
30-
year-old patient with a 6.5-cm post-traumatic pseudoa-
neurysm of the left axillary artery two months after a knife
stab wound of the shoulder. The patient showed axillary
fullness and signs of severe brachial plexus compression. A
surgical repair was undertaken. The aneurysm was excluded
and a saphenous vein interposition was performed. The early
and late postoperative periods were uneventful. This is prob-
ably not only the largest axillary artery pseudoaneurysm
ever reported, but also the first secondary to a stab wound.
Keywords:
axillary artery, pseudoaneurysm, stab wound
Submitted 12/2/10, accepted 5/6/12
Cardiovasc J Afr
2012;
23
:
e4–e6
DOI: 10.5830/CVJA-2012-045
Aneurysms and pseudoaneurysms of the axillary arteries (AA)
are extremely rare but well-documented phenomena.
1-5
Only five
cases have been reported in the surgical literature up to 1990.
Most AA pseudoaneurysms are late consequences of blunt
arterial injuries around the shoulder, and particularly anterior
shoulder dislocation
2-6
or humeral head fractures.
7,8
Although not
reported, penetrating wounds such as gunshot and stabbing may
also result in such conditions.
The major complications are from the initial brachial plexus
injury or its secondary compression. Rupture with haemorrhage
can be life threatening, and distal embolisation may result in
ischaemia of the arm.
We present a rare case of a patient with a 6.5-cm
pseudoaneurysmof the left AA. The patient was treated surgically.
To the best of our knowledge, this is the first pseudoaneurysm of
an AA secondary to a stab wound.
Case report
The patient, a 30-year-old labourer, was seen at the surgery
department of the Yaoundé General Hospital in Cameroon. He
presented with a history of gradually increasing swelling of his
left axilla over the previous two months.
There had been a penetrating shoulder injury caused by a
long knife during a fight three weeks before the start of the
axillary swelling. Profuse haemorrhage was managed by a
blood transfusion and wound closure in a peripheral centre. No
other past medical illness was reported by the patient. Due to
an increase in the axillary mass, associated with neurological
dysfunction of the upper extremity, he was advised to come to
our vascular department.
On examination, the axillary mass measured 8 cm, was
firm, slightly painful and pulsatile. No bruit was audible on
auscultation (Fig. 1). The distal pulses were difficult to detect
but the arm was warm with normal colouration. Hypo-aesthesia,
paralysis and amyotrophy of the upper extremity were present.
Ultrasonography followed by computed tomography
angiography (CTA) showed a left AA pseudoaneurysm, 6.5 mm
Department of Surgery, Yaoundé General Hospital,
Cameroon
M FOKOU, MD,
VC EYENGA, MD
JJ PAGBE, MD
Department of Surgery, Limbé General Hospital, Cameroon
A CHICHOM MEFIRE, MD
Departments of Surgery and Radiology, Yaoundé General
Hospital, and Department of Surgery, Yaoundé University
Teaching Hospital, Cameroon
ML GUIFO, MD
Department of Vascular Surgery and Kidney
Transplantation, University of Düsseldorf, and Vascular
Centre, Kampt-Lintford, Germany
W SANDMANN, MD
Fig. 1. External view of the axillary artery pseudoaneu-
rysm.
