Learning objectives
To summarize the anatomic key points of the arterial anatomy of the chest wall and shoulder based upon the most relevant literature and to establish the zonal vascularization of this region in a model based on CT scan images.
Background
Arterialanatomyof thechest wall andshoulderis always a challenge for both diagnostic and therapeutic purposes, making prompt identification of vessels difficult. Moreover, spontaneous hematomas occur unfrequently in this area,involving the abdominal waist in the majority of patients (mainly affecting the iliopsoas muscles and the rectus abdominissheath)[1].
Mortality rates of spontaneous soft tissue hematomas reach 27% in some series, with risk factors such as hematoma volume and retroperitoneal location independently associated to fatal outcome[2].
The main risk factor associated tospontaneous hematomas is anticoagulant therapy[2].Their increasing prescription,alsoboosteddue to Covid-19...
Findings and procedure details
Topographyand irrigation[3, 4, 5]
CT scan images provided helptoillustrate the zonal vascularization (figures 1 - 7), while figure 8summarizes the irrigation of the different arteries.
[Fig 1]
[Fig 2]
[Fig 3]
[Fig 4]
[Fig 5]
[Fig 6]
[Fig 7]
[Fig 8]
Subclavian artery
The subclavian arteryarisesfrom the brachiocephalic trunkon the right,and directly from theaortic arch on the left.Itexitsthe thorax between the anterior and middle scalene, and coursesbetween the clavicle and the first rib, giving rise to multiples branches, describedbelowin a proximal to distal order:
Vertebral...
Conclusion
Arterial anatomy of the chest wall and shoulder is complex and inconstant, and since spontaneous hematomas occur infrequently in this area, management of these patients might not be the most adequate.Our hope isto offera brief andusefulguidethroughthis educational poster.
Personal information and conflict of interest
M. González Estévez:
Nothing to disclose
M. Gonzalez Leyte:
Nothing to disclose
F. Carretero López:
Nothing to disclose
A. Álvarez Luque:
Nothing to disclose
M. Echenagusia Boyra:
Nothing to disclose
E. Calleja Carton:
Nothing to disclose
A. Fernández Tamayo:
Nothing to disclose
C. Segura Escribano:
Nothing to disclose
J. Miranda Bautista:
Nothing to disclose
References
A. Dohanet al.Spontaneous soft tissue hematomas.Diagnostic and Interventional Imaging, Volume 96, 2015,p.789-796.
M. Barral et al.Predictors of Mortality from Spontaneous Soft-Tissue Hematomas in a LargeMulticenterCohort Who Underwent PercutaneousTransarterialEmbolization.Radiology 2019291:1, 250-258.
Gray’s Anatomy,42ndedition, Chapter 81, p. 85– 88.
Perforator Flaps: Anatomy, Technique, & Clinical Applications, Second Edition, Phillip. N.Blondeel.
K. León Torres et al.Variantesderamasde la arteriaaxilar. Med. Leg. Costa Rica, 2017.