Dissecting left subclavian artery aneurysm: an unusual presentation of coarctation of the aorta

Focal dissection and rupture of left atherosclerotic subclavian artery: a rare cause of haemothorax

We report a rare case of a focally dissected and ruptured atherosclerotic left subclavian artery leading to haemothorax. A man in his 50 s who suffered from hypertension and gout was found dead in bed unexpectedly. Postmortem examination showed a focally dissected and ruptured atherosclerotic left subclavian artery with relatively disease-free aorta and major branches. Although theoretically possible, focal atherosclerosis of left subclavian artery compounded by hypertension causing focal dissection and rupture is not previously reported in literature.

Post-COVID isolated subclavian artery dissection with multiple cerebral infarctions

Background

Coronavirus disease 2019 (COVID-19) is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity, yet it also causes multiple organs dysfunction in affected patients. There is a strong evidence that it increases the susceptibility of cerebrovascular strokes in such patients. Besides this prothrombotic complication, arterial dissection can be one of its mechanisms increasing the risks of stroke.

Case presentation

Herein, we report a case of spontaneous isolated subclavian artery dissection in a COVID-19 patient. Sixty-one-year-old female presented with spontaneous isolated subclavian artery dissection without any traumatic events nor history of connective tissue disorders. She had left upper limb ischemia followed by cerebellar, thalamic and occipital infarctions. Whether this patient’s subclavian artery dissection was triggered by exaggerated inflammatory response or arteriopathy secondary to COVID-19 remains speculative.

Conclusions

Nonetheless, arterial dissection can be one of its complications, it is essential for treating physicians to be attentive for the diversity of COVID-19 clinical manifestations.

Subclavian artery dissection

Subclavian artery dissection is rarely reported in the medical literature. We describe the case of a 54-year-old male who presented with multifocal ischemic stroke and was found to have a subclavian artery dissection. We provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

Spontaneous subclavian artery dissection: a pain in the neck diagnosis

Isolated subclavian artery dissection is a very rare condition in the absence of trauma or procedures. A 36-year-old woman with a history significant for uncontrolled hypertension presented with a sudden onset of left shoulder and neck pain that woke the patient from sleep. A CT angiogram of the chest revealed a left subclavian artery dissection. The patient was admitted to the hospital for blood pressure control.

Coarctation of the aorta associated with aneurysm of the left subclavian artery

Coarctation of the thoracic aorta is not often diagnosed after childhood. The combination of subclavian artery aneurysm in association with coarctation of the aorta is even less frequent. A review of the literature elicited only seven previously reported cases of such an association. Presented herein is a case of a young adult with coarctation of the aorta and secondary left subclavian artery aneurysm, diagnosed incidentally. We discuss the incidence of these rare conditions and possible causes for their co-existence.

Intracranial aneurysms and cervicocephalic arterial dissections associated with congenital heart disease

OBJECTIVE

The number of patients with congenital heart disease who survive to adolescence and adulthood continues to increase. We review our experience with noninfectious intracranial aneurysms and cervicocephalic arterial dissections in patients with congenital heart disease, expanding the clinical spectrum of the cerebrovascular abnormalities that may be encountered in this group of patients.

METHODS

All patients with congenital heart disease and intracranial aneurysms of cervicocephalic arterial dissections, who were evaluated at the Mayo Clinic between 1969 and 1992, were identified.

RESULTS

Congenital heart disease was diagnosed in 3 (8%) of 36 children with intracranial aneurysms, in 5 (0.3%) of 1994 adults with intracranial aneurysms, in 1 (4%) of 25 children with cervicocephalic arterial dissections, and in 5 (2%) of 250 adults with cervicocephalic arterial dissections. The mean age of the 14 patients was 32 years (range, 13-58 yr). The congenital heart disorders consisted of complex cardiac anomalies in three patients (truncus arteriosus, transposition of the great arteries, and tricuspid atresia in one patient each), pulmonic valve or arterial stenosis in two patients, aortic coarctation in four patients, and bicuspid aortic valve in five patients. Only one patient had an intracranial aneurysm and coarctation of the aorta.

CONCLUSION

Individuals with a variety of congenital heart disorders may be at an increased risk of intracranial aneurysm development and cervicocephalic arterial dissection, particularly in adolescence. The muscular arteries of the head and neck are derived from neural crest cells and the neural crest is also of major importance in early cardiac development, suggesting that an abnormality of the neural crest may be the common pathogenetic factor explaining this association.

Aortic coarctation with two intercostal aneurysms, appearing radiographically as a subclavian aneurysm. A case report

The authors present a case of adult aortic coarctation with two associated intercostal aneurysms and poor left ventricular function. The intercostal aneurysms appear, radiographically, as a subclavian aneurysm. The case illustrates, in aortic coarctation, the potential difficulty in defining the anatomy of the associated vascular aneurysms. The authors also demonstrate that the left ventricular function markedly improves after resection of the aortic coarctation.