Fragmentation injury to the innominate artery in a three-year-old child

The management of vascular trauma in pediatric patients presents numerous challenges, especially in an austere environment. We present the case of a 3-year-old girl who sustained multiple fragmentation injuries to the right chest and right upper extremity as a result of combat activity in Iraq. This resulted in an occult pseudoaneurysm of the innominate artery identified during exploration of her right chest for a persistent air leak from the right side of the chest. Computed tomography angiography delineated the injury, which was surgically repaired. This report demonstrates the type of challenging cases encountered in a combat zone and illustrates the need for a national database of such injuries in pediatric patients to better inform surgical decision making.