title: Axillary artery pseudoaneurysm resulting in brachial plexus injury in a patient taking new oral anticoagulants.
abstract: We discuss the case of an independent 80-year-old Caucasian woman, being treated with new oral anticoagulants for a previous deep vein thrombosis, who had fallen on her right shoulder. She made a delayed presentation to the emergency department with a wrist drop in her right dominant hand. She had right arm bruising with good distal pulses but had a global neurological deficit in the hand. Plain radiographs of the shoulder, humerus, elbow, forearm and wrist demonstrated no fractures. MRI showed a significant right axillary lesion distorting the surrounding soft tissues, including the brachial plexus, and CT with contrast confirmed this to be a large axillary pseudoaneurysm. This was treated with an endovascular stent resulting in slightly improved motor function, but the significant residual deficit required subsequent rehabilitation to improve right upper limb function.
authors.affiliation: Trauma & Orthopaedic Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Monem
authors.affiliation: The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Mohamad Khalid
authors.initials: MK
authors.lastname: Iskandarani
authors.affiliation: Trauma & Orthopaedic Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK.
authors.forename: Kishan
authors.initials: K
authors.lastname: Gokaraju
mesh_terms: D000058:Accidental Falls; D000284:Administration, Oral; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology*; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001366:Axillary Artery; D001917:Brachial Plexus / Q000293:injuries*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D000070599:Shoulder Injuries / Q000150:complications*
chemical_list: D000925:Anticoagulants