A 54-Year-Old Man With Neck Swelling, Respiratory Distress, and Hoarseness

[摘要] Figures Figure 1 A, Diffuse right neck swelling. B, Grayscale image on ultrasonography showing an anechoeic lesion with a 2-mm tiny defect at the neck (white arrow) and a communication with right subclavian artery. C, Color Doppler demonstrating bidirectional blood flow (blue and red) in the lesion. D, Spectral Doppler in the region of defect showing biphasic reciprocating arterial waveforms. Figure 2 A, CT angiography showing right subclavian pseudoaneurysm causing compression of the trachea. B, Percutaneous injection of cyanoacrylate and lipoidal mixture into the pseudoaneurysm. C, Post procedure ultrasonography image confirming no flow into the pseudoaneurysm. A 54-year-old man, a known case of chronic kidney disease, presented to the ED with rapidly enlarging diffuse neck swelling on the right side (Fig 1A), respiratory distress, and hoarseness of the voice. On examination, there was a diffuse swelling on the right side of the neck and the trachea was pushed to the left. An inspiratory stridor was audible on auscultation. A week prior to presentation, he had undergone right internal jugular vein cannulation for a dialysis catheter placement. An ultrasonography examination of the neck was carried out in the ED which revealed an anechoic lesion measuring 40 × 30 × 20 mm with a 2-mm defect at the neck and a communication with right subclavian artery (Fig 1B).

[学科分类] 呼吸医学