Case presentation
A 60-year-old female patient was referred for consultation due to a neck mass. Doppler ultrasound revealed the presence of arterial flow and doppler signals at the suspected location and computed tomography (CT) scan confirmed the presence of a high-lying right brachiocephalic artery (RBCA) extending above the thoracic outlet (Fig 1, black arrow). The bifurcation of the brachiocephalic trunk was located cranially at the right sternoclavicular joint and caudally at the right thyroid lobe. No aneurysmal expansion, stenosis, or compression of the trachea or venous structures were identified. The branching pattern of the great arteries was normal (Fig 1, red and yellow arrows). The vascular surgeon recommended follow-up.
High-lying RBCA is an extremely rare congenital vascular disorder of the aortic arch which extends outside the thoracic outlet. Ignorance of this entity can cause injury to the RBCA and/or its branches during surgical procedures with an anterior approach to the neck such as in thyroid surgery,
1
neck dissection- Gil-Carcedo E
- Gil-Carcedo LM
- Vallejo LA
- et al.
High-riding innominate artery in neck surgery.
Acta Otorrinolaringol Esp. 2012 Sep-Oct; 63 (English, Spanish): 396-398https://doi.org/10.1016/j.otorri.2011.03.006
2
and tracheotomy.3
These injuries are commonly fatal and should be recognized before any procedure to the neck. Pulsation in the anterior neck, in this regard, should raise the suspicion of an aberrant major artery, and Doppler ultrasound should be used to identify the pulsating vessel.Conflicts of interest
The authors declare no conflicts of interest.
Funding
No funding was received for this study.
References
- High-riding innominate artery in neck surgery.Acta Otorrinolaringol Esp. 2012 Sep-Oct; 63 (English, Spanish): 396-398https://doi.org/10.1016/j.otorri.2011.03.006
- Risk assessment of high-lying innominate artery with neck surgery.Acta Otolaryngol. 2017 Mar; 137: 315-319https://doi.org/10.1080/00016489.2016.1232489
- Innominate artery hemorrhage complicating tracheotomy.Ann Otol Rhinol Laryngol. 1970 Apr; 79: 301-306https://doi.org/10.1177/000348947007900210
Article info
Publication history
Published online: September 12, 2022
Accepted:
September 8,
2022
Received:
December 28,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
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