CTICasesTraumatic Right Subclavian Artery-to-Vein Fistula and Pseudoaneurysm
Imaging findings
Contrast-enhanced CT and conventional angiography of the chest and upper extremity in a trauma patient demonstrate a massive pseudoaneurysm and direct arteriovenous fistula between the right subclavian/axillary artery and vein. Early venous contrast filling is seen draining rapidly into the right brachiocephalic vein and superior vena cava during the early arterial phase, adjacent to subtle posterior rib fractures.
Key takeaways
High-energy blunt or penetrating trauma can cause vascular laceration leading to pseudoaneurysms and traumatic arteriovenous fistulas. Arteriography or high-quality CT angiography is essential to define the anatomy of the communication and guide endovascular or surgical repair, particularly when clinical signs of early venous filling are suspected.
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