Learning objectives
1.
Review the vascular anatomy of the upper limb.
2.
Describe the spectrum of imaging findings in upper limb vascular trauma.
Background
Upper limb vascular injuries are frequently seen in the setting of both blunt and penetrating trauma.
In suspected cases,
CT is a useful,
non-invasive technique to evaluate their extent.
Due to the complexity of the vascular anatomy of the upper limb,
identification of vascular injury can be overlooked.
Findings and procedure details
Normal arterial vascular anatomy [1]:
The upper limb vasculature originates at the aortic arch and extends through to the digital arteries (Figure 1).
Subclavian artery
Arises from the brachiocephalic artery on the right and aortic arch on the left,
running posterior to the subclavian vein and anterior scalene muscles
Five main branches: vertebral artery,
internal thoracic artery (internal mammary artery),
thyrocervical trunk,
costocervical trunk,
and dorsal scapular artery
Blood supply to head,
neck,
chest and scapula
Axillary artery
Continuation of the subclavian artery as it...
Conclusion
Knowledge of vascular anatomy and the range of radiological findings in vascular injury are crucial in the prompt diagnosis of traumatic injuries of the upper limb.
Reporting findings accurately,
enables appropriate and expeditious clinical management.
Personal information
Dr Mitesh Naik,
Radiology Specialist Trainee,
Imperial College Healthcare NHS Trust,
London,
UK
Dr Andreas Shekkeris,
Consultant Radiologist,
Imperial College Healthcare NHS Trust,
London,
UK
Dr Jadesola Ekpe,
Radiology Specialist Trainee,
Imperial College Healthcare NHS Trust,
London,
UK
Mr Mansoor Khan,
Consultant Trauma Surgeon,
Imperial College Healthcare NHS Trust,
London,
UK
Dr Rowena Johnson,
Consultant Radiologist,
Oxford University Hospitals NHS Trust,
Oxford,
UK
Dr Elika Kashef,
Consultant Radiologist,
Imperial College Healthcare NHS Trust,
London,
UK
Dr Elizabeth Dick,
Consultant Radiologist,
Imperial College Healthcare NHS Trust,...
References
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Bozlar U,
Ogur T,
Norton P,
Khaja M,
All J,
Hagspiel K.
CT Angiography of the Upper Extremity Arterial System: Part 1 – Anatomy,
Technique and Use in Trauma Patients.
AJR. 2013; 201:745-752.
2.
Bergman RA,
Afifi AK,
Miyauchi R,
Opus II.
Illustrated Encyclopedia of Human Anatomic Variation. 2010.
Cardiovascular System: Arteries: Upper Limb.
3.
Wani ML,
Ahangar AG,
Ganie FA,
Wani SN,
Wani N.
Vascular Injuries: Trends in Management.
Trauma Mon. 2012; 17(2):266-269.
4.
Iacobellis F,
Ierarti AM,
Mazzei MA,
Magenta Biasina A,...