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Case Reports
. 2013 Mar;22(1):69-74.
doi: 10.1055/s-0033-1333862.

Subclavian aneurysm presenting with massive hemoptysis: a case report and review of the literature

Hilary A Brown  1 , John E Aruny  2 , John A Elefteriades  3 , Bauer E Sumpio  1
Affiliations
Case Reports

Subclavian aneurysm presenting with massive hemoptysis: a case report and review of the literature

Hilary A Brown et al. Int J Angiol. 2013 Mar.

Abstract

We present a case of a 70-year-old male with a past medical history of coronary artery bypass grafting and end stage renal disease who presented with massive hemoptysis. He had a history of methicillin-resistant Staphylococcus aureus endocarditis, with infection and removal of endocardial pacing leads. His work-up revealed a 2.9-cm proximal left subclavian artery aneurysm. Bronchoscopy confirmed bright red blood in the left upper lobe bronchus and coronary angiography confirmed a patent left internal mammary artery (LIMA) to left anterior descending bypass. Because of the consideration of maintaining coronary perfusion via the LIMA while excluding the subclavian aneurysm, he underwent a left carotid to left axillary artery bypass graft followed by deployment of an Amplatzer II vascular plug just distal to the aneurysm. A thoracic endograft was then deployed to exclude the origin of the subclavian. A review of the literature reveals hemoptysis as a rare presentation of a subclavian aneurysm. We discuss approaches to this challenging clinical problem, ranging from open repair to hybrid approaches.

Keywords: aneurysm; endovascular repair; hemoptysis; hybrid; subclavian.

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Figures

Fig. 1
Fig. 1
CT scan showing ground glass opacity at left lung base (arrow).
Fig. 2
Fig. 2
CT scan showing subclavian aneurysm (arrow).
Fig. 3
Fig. 3
Preoperative angiogram showing left subclavian pseudoaneurysm (arrow).
Fig. 4
Fig. 4
Intraoperative imaging demonstrating patent left carotid axillary bypass graft (long arrow) with patent left internal mammary bypass graft (short arrow).
Fig. 5
Fig. 5
Patent carotid axillary bypass graft with subclavian aneurysm still filling before placement of the TX2 device. An Amplatz plug has been deployed in the identified location (arrow).
Fig. 6
Fig. 6
Patent carotid axillary bypass graft (long arrow) with TEVAR in place and patent left internal mammary bypass graft (short arrow). An Amplatz plug prevents backfilling of the aneurysm from the carotid axillary bypass graft.
Fig. 7
Fig. 7
Postoperative CT scan reconstruction showing patent carotid axillary bypass graft (short white arrow) with TEVAR in place (long white arrow). An Amplatz plug (black arrow) prevents backfilling of the aneurysm.
See this image and copyright information in PMC

References

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