A 25-year-old patient presents after a motor vehicle collision with a fracture of the right clavicle. A bruit is heard over the right upper chest. What is the most appropriate next step in management?

A 25-year-old patient presents after a motor vehicle collision with a fracture of the right clavicle. A bruit is heard over the right upper chest. What is the most appropriate next step in management?

• A. Doppler ultrasound
• B. Chest X-ray only
• C. CT angiogram of chest and arm
• D. MRI of the neck and chest

Answer: (C)

When a clavicle fracture is accompanied by a bruit over the upper chest, this raises strong suspicion for vascular injury to the subclavian/innominate arteries. The best way to rapidly, accurately assess the extent of any arterial injury and plan management is CT angiography of the chest and involved upper extremity. CT angiography provides detailed visualization of the central and peripheral arteries in one study, guiding decisions about surgical or endovascular repair. It is fast, widely available, and more informative for vascular injury than other tests in this setting. Doppler ultrasound has limited value for central vessels and chest structures, so it cannot reliably assess potential injury to the subclavian or brachiocephalic arteries. A chest X-ray alone won’t evaluate vascular injury. MRI is not ideal in the acute trauma setting due to time, availability, and patient stability requirements.

When a clavicle fracture is accompanied by a bruit over the upper chest, this raises strong suspicion for vascular injury to the subclavian/innominate arteries. The best way to rapidly, accurately assess the extent of any arterial injury and plan management is CT angiography of the chest and involved upper extremity.

CT angiography provides detailed visualization of the central and peripheral arteries in one study, guiding decisions about surgical or endovascular repair. It is fast, widely available, and more informative for vascular injury than other tests in this setting.

Doppler ultrasound has limited value for central vessels and chest structures, so it cannot reliably assess potential injury to the subclavian or brachiocephalic arteries. A chest X-ray alone won’t evaluate vascular injury. MRI is not ideal in the acute trauma setting due to time, availability, and patient stability requirements.