A 30-year-old man sustains blunt trauma to the anterior chest. He has severe anterior neck pain, stridor, and difficulty swallowing. Chest X-ray shows asymmetry of the medial clavicles. The most likely diagnosis and the reason this is an emergency are:

• A Medial clavicle physeal fracture compressing the recurrent laryngeal nerve
• B Anterior sternoclavicular dislocation causing thoracic outlet compression
• C Posterior sternoclavicular dislocation threatening the mediastinal great vessels ✓
• D Manubrium fracture with haemopericardium

Explanation

Posterior dislocation of the sternoclavicular joint drives the medial clavicle retrosternally toward the innominate artery, carotid artery, trachea, and oesophagus, so airway compromise and vascular injury make it a true emergency. It is easily missed because the joint is poorly seen on plain films; a chest film showing asymmetric medial clavicles plus dysphagia or stridor should prompt urgent contrast-enhanced CT. Anterior dislocation is far more common but produces only a visible bump and is not life threatening.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.