A.P. Joseph, A. Newey, A. Glover, W. Mohabbat

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Penetrating Neck injury is relatively uncommon. The case involved a young male who had hit a sledgehammer onto an axe head embedded in the stump of a tree. A 5 mm metal fragment had broken off and lodged in the left side of his neck in Zone 2 and then travelled down to lodge in Zone 1. There was a large haematoma over his left neck anterior to the left sternomastoid muscle with a small entry wound and there was no associated crepitus or it was non pulsatile. CXR showed a metallic foreign body at the left root of his neck at the apex of his left lung and superior to the medial border of the left clavicle. A subsequent CT angiogram showed the metallic object in the left base of his neck anterosuperior to the left subclavian artery and anterior to the left thyrocervical trunk. There was active arterial contrast extravasation seen which was thought to be arising from the thyrocervical trunk or left subclavian artery.  Subsequent surgical exploration demonstrated transection of the left thyrocervical trunk which was repaired after balloon occlusion of the left subclavian artery. The patient developed a thrombus in his L brachial artery which was removed. On day 2 he developed neurological symptoms which included headache, diplopia and a right inferior quadrantanopia. He was found to have a local dissection in the left subclavian artery which was treated with anticoagulation for 12 weeks. He made a full recovery from his initial vascular injury and the complications.

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