(1719) A Unique Case of Acute Compartment Syndrome of the Pectoralis Major Muscle

Introduction: Acute compartment syndrome is a surgical emergency caused by an increased pressure within a closed fascial compartment. If unidentified or untreated can lead to ischemia and necrosis of the compartment, and associated structures causing permanent damage. Arterial blood flow through capillaries into venous drainage is dependent on the pressure differential. The pathophysiology behind acute compartment syndrome is a loss of flow differential due to increased pressure within a closed space. This loss of pressure differential leads to decreased blood flow into and out of the effected compartment. Acute compartment syndrome is a surgical emergency. Any fascial compartment can be afflicted with compartment syndrome, most commonly are the extremities, abdominal, and gluteal compartments.

Description: A 45-year-old male presented to the trauma bay after being found down for an unknown period of time. On evaluation patient was acutely encephalopathic and unable to provide further history but stated that his left chest was exquisitely tender. On exam, the patient had complete loss of sensory and motor function of his left upper extremity (LUE) with doppler-able pulses. His left chest was firm to touch, and his LUE was cool. He was found to have an acute kidney injury, hyperkalemia, elevated creatinine kinase, and hypocalcemia. Renal replacement therapy was initiated, and the patient underwent decompression of the pectoralis major muscle due to acute compartment syndrome and brachial plexopathy. Patient ultimately regained sensation in his LUE but continued to have a wrist drop. He otherwise also regained motor function of his LUE as well. He was able to be titrated off renal replacement and continues to follow with physical therapy.

Discussion: This case exemplifies a unique example of compartment of the pectoralis major muscle, without involvement of the pectoralis minor which is more commonly known point of constriction. The diagnosis of compartment syndrome is imperative to a timely operative intervention. There have not been previously documented cases of pectoralis major muscle compartment syndrome with brachial plexopathy. The component of brachial plexopathy if left untreated could have resulted in entire loss of the LUE or its function as nerves are more sensitive to ischemia.