title: Fragmentation injury to the innominate artery in a three-year-old child.
abstract: The management of vascular trauma in pediatric patients presents numerous challenges, especially in an austere environment. We present the case of a 3-year-old girl who sustained multiple fragmentation injuries to the right chest and right upper extremity as a result of combat activity in Iraq. This resulted in an occult pseudoaneurysm of the innominate artery identified during exploration of her right chest for a persistent air leak from the right side of the chest. Computed tomography angiography delineated the injury, which was surgically repaired. This report demonstrates the type of challenging cases encountered in a combat zone and illustrates the need for a national database of such injuries in pediatric patients to better inform surgical decision making.
authors.affiliation: Trauma and Acute Care Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Greene
authors.affiliation: Trauma and Acute Care Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas; Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Electronic address: jeremy.w.cannon@us.army.mil.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Cannon
authors.affiliation: Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Vascular Surgery, David Grant Medical Center, Travis Air Force Base, Fairfield, California.
authors.forename: W Darrin
authors.initials: WD
authors.lastname: Clouse
authors.affiliation: Borgess Heart Institute, Kalamazoo, Michigan.
authors.forename: Jerry W
authors.initials: JW
authors.lastname: Pratt
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000601:surgery; D000792:Angiography / Q000379:methods; D001134:Arm Injuries / Q000175:diagnosis* / Q000601:surgery; D016122:Brachiocephalic Trunk / Q000293:injuries* / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007493:Iraq; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D018570:Risk Assessment; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014857:Warfare