Halleluyah Konno, Masakazu Nitta, Norihiro Watanabe, Mitsuyuki Miyazato, Akane Horiuchi

Department of Emergency Medicine, Tsubame Rosai Hospital, Niigata, Japan

Keywords: Internal mammary artery injury, mediastinal hematoma, sternum fractures, traffic accident


Internal thoracic artery (ITA) injuries associated with sternal fractures can lead to shock. Several studies have documented injuries resulting in hemorrhagic shock, yet there is limited reporting on obstructive shock. Opinions differ regarding which is superior between transcatheter arterial embolization (TAE) and open thoracotomy. We report the case of an 80 year old female patient presented with blunt chest trauma when driving. Her vital signs were normal. However, ultrasonography revealed a hypoechoic anterior mediastinal lesion. Her blood pressure decreased immediately before undergoing a computed tomography (CT) scan. The CT scan showed a sternal fracture, anterior mediastinal extravasation, and dilation of the inferior vena cava. TAE was performed on both internal thoracic arteries, and the patient was transferred to a hospital where an open thoracotomy could be performed. The patient was treated conservatively and discharged without sequelae. Obstructive shock caused by an ITA injury with a sternal fracture can be successfully treated using TAE.

How to cite this article: Konno H, Nitta M, Watanabe N, Miyazato M, Horiuchi A. Obstructive shock induced by internal thoracic artery injury with traumatic sternal fracture. Turk J Emerg Med 2024;24:172-5.

Author Contributions

H.K. designed the study, the main conceptual ideas, and the proof outline and collected the data. N.W., M.M., and A.H. aided in interpreting the results and worked on the manuscript. M.N. supervised the project. H.K. wrote the manuscript with support from M.N. and N.W. All authors discussed the results and commented on the manuscript.

Conflict of Interest

None declared.

Financial Disclosure



We thank Toru T. MD, for reading the CT images and performing TAE for the patient. We also thank Editage (www.editage.jp) for the English language editing.