Our objective was to evaluate whether physical examination in conjunction with chest X-ray can accurately diagnose the presence of significant @entity1317 in penetrating periclavicular @entity130 . Results from a management protocol for penetrating periclavicular @entity130 were reviewed for the period January 1992 through December 1996 at an urban Level I @entity130 center. All @entity1 requiring angiography for periclavicular penetrating @entity130 with trajectory of the @entity130 between the lateral border of the manubrium and the anterior axillary line were entered into the management protocol. All @entity1 underwent anterior-posterior chest radiography on arrival to the @entity130 center and 6 hours after admission. Tube thoracostomy was placed if clinically indicated on presentation or for X-ray findings. Clinical assessment was performed on all @entity1 , with emphasis placed on the presence of "hard" signs for @entity1317 . In addition to accepted hard signs for @entity1317 , significant chest tube output (>1000 cc) and chest X-ray findings consistent with significant @entity548 were also considered hard signs for @entity1317 . Assuming hemodynamic stability, all @entity1 with suspected @entity1317 based on wound trajectory or clinical findings consistent with @entity1317 underwent angiography. Forty-six @entity1 were entered into the protocol with 30 left-sided injuries and 16 right sided injuries. The majority of injuries were secondary to gunshot wounds (31), with 14 stab wounds and 1 shotgun injury. Emergency room chest X-ray results revealed 32 negative chest X-rays, 7 pneumothoraces, 2 hemopneumothoraces, 2 hemothoraces, and 3 chest tubes placed before initial chest X-ray. A total of 7 injuries were diagnosed, with 1 missed injury, resulting in a sensitivity of 86 per cent for clinical assessment. The missed injury was a @entity2849 of an axillary artery secondary to a self-inflicted shotgun wound. One mortality occurred in this series, which was a death in the operating room secondary to @entity190 from an @entity1317 . We conclude that clinical assessment can adequately diagnose the presence of surgically significant @entity1317 in periclavicular penetrating injuries with trajectories lateral to the manubrium.

The role of angiography in periclavicular penetrating XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhage'] @entity130 :: ('MESH:D014947', 'Disease') :: ['injury falling', 'trauma'] @entity190 :: ('MESH:D006473', 'Disease') :: ['blood loss'] @entity1317 :: ('MESH:D057772', 'Disease') :: ['subclavian/axillary arterial injury', 'vascular injury', 'axillary artery injury'] @entity2849 :: ('MESH:D017541', 'Disease') :: ['pseudoaneurysm']
@entity130 :: (MESH:D014947,Disease) :: ['trauma']
