Intrathoracic left subclavian artery aneurysm: report of a case

Mycotic subclavian artery aneurysms: a scoping review

Introduction

Mycotic subclavian artery aneurysms (SAAs) are a very rare disorder.

Aim

To provide an overview of current knowledge on clinical features, management strategies and outcome evaluations of mycotic SAAs.

Material and methods

The study materials were based on comprehensive literature retrieval of publications of mycotic SAAs published between 2000 and 2023.

Results

Contaminated mechanical injuries and abscess erosions of the arterial walls are mechanisms of mycotic SAAs. The diagnosis relies on detection of pathogenic microorganisms by cultures or microbiological investigations of blood, other fluids and infected tissues as well as medical imaging visualization. The indications for an interventional therapy were poor general condition, high surgical risk, and rescue exclusion for a ruptured pseudoaneurysm. Three (9.1%) pre-treatment deaths were a result of sudden rupture of the mycotic SAAs and thus they lost the opportunity of treatment. All post-treatment deaths occurred in the interventional patient group, whereas the causes of death seemed to be unrelated to mycotic SAAs per se or to treatments of choice. Patient outcome evaluations revealed no significant difference between different treatments of choice. No significant predictive risk factors were responsible for patient outcomes.

Conclusions

Once a diagnosis of mycotic SAA is made, sensitive antibacterial drugs are applied immediately to control the infection and control aneurysmal progression. Early treatment is conducted as soon as possible to avoid aneurysmal rupture. A decision on treatment of choice is made based on the patient's specific condition. Antibacterial drug use is continued for about 6 weeks after surgical or interventional therapy.

Interesting case of left subclavian pseudoaneurysm in a child managed successfully

Subclavian artery aneurysm is extremely rare, and further aneurysm in a 3-year-old child is more exceptional. Most common causes of subclavian artery aneurysms are atherosclerosis, poststenotic thoracic outlet syndrome, infectious, trauma, and inflammatory arteritis, and connective tissue disorders. Pseudoaneurysms may be due to trauma or any iatrogenic injury to subclavian artery. We present a case report of a 3-year-old male child presented to us with recurrent cough without expectoration for 4-months duration due to compression by a large subclavian artery aneurysm. Patient was successfully managed surgically through left thoracotomy approach. After operation, the patient improved symptomatically. Child was asymptomatic at 3-month follow-up.

Giant Subclavian Artery Aneurysm

We report the case of a 37-year-old construction executive presenting with chest pain, shortness of breath, and dizziness on exertion secondary to a giant left subclavian artery aneurysm and aortic valvular disease.