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JAMA Surgery Clinical Challenge
August 2015

Arm Ischemia and Posterior Stroke in a Patient With a Pulsatile Mass in the Right Upper Side of Chest

Author Affiliations
  • 1Department of Vascular Surgery, University of Cincinnati, Cincinnati, Ohio
JAMA Surg. 2015;150(8):811-812. doi:10.1001/jamasurg.2015.0686

A man in his late 60s with a history of laryngeal cancer was transferred to our institution. The patient had undergone laryngectomy with radiation, modified radical neck dissection, and a pectoralis major flap into the right-sided neck wound in 1998. This operation was subsequently complicated by right carotid blowout requiring right-sided carotid artery ligation on November 5, 2005. The patient initially presented to our hospital with a Glasgow Coma Scale score of 3. Findings from computed tomography of the head at the referring hospital showed acute right-hemispheric stroke with left-sided hemiparesis.

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