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Case Reports
. 2015;8(1):62-5.
doi: 10.3400/avd.cr.14-00116. Epub 2015 Mar 9.

Emergent rescue operation for expanding mycotic pseudoaneurysm causing hemoptysis, originating from right subclavian artery

Kosuke Mukaihara  1 , Hiroyuki Yamamoto  1 , Kenichi Arata  1 , Takayuki Ueno  2 , Yutaka Imoto  1 , Ryuzo Sakata  3
Affiliations
Case Reports

Emergent rescue operation for expanding mycotic pseudoaneurysm causing hemoptysis, originating from right subclavian artery

Kosuke Mukaihara et al. Ann Vasc Dis. 2015.

Abstract

Mycotic pseudoaneurysm of the subclavian artery is uncommon and its therapeutic strategy has not been established. We report a case of 81-year-old woman with mycotic pseudoaneurysm in the right subclavian artery. Blood culture showed Enterobacter cloacae. Because of hemoptysis and acute expansion of the pseudoaneurysm, emergent coil embolization was performed, but failed. The patient underwent urgent operation for an en-bloc resection of the pseudoaneurysm after aorto-right common carotid artery bypass followed by omentum packing. The patient underwent continuous wound irrigation for 3 weeks. The postoperative course was uneventful and without recurrence of infection.

Keywords: mycotic pseudoaneurysm; saphenous vein graft; subclavian artery.

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Figures

Fig. 1
Fig. 1
Chest CT at admission. On the chest CT, the pseudoaneurysm (30 mm × 40 mm), appeared to have originated from the right innominate artery, and to have massive gas production and a surrounding irregular fibrous wall. CT: computed tomography.
Fig. 2
Fig. 2
Chest CT immediately before operation. There was a remarkable increase in the size of the psuedoaneurysm (60 mm × 70 mm) and the projection area of the blood within the pseudoaneurysm (a). Three- dimensional CT showed that the pseudoaneurysm developed from the origin of the right subclavian artery (b). CT: computed tomography.
Fig. 3
Fig. 3
Post operative three-dimensional CT. The pseudoaneurysm was completely resected with the surrounding right innominate artery and the origin of the right subclavian artery. The SVG from the ascending aorta to the RCCA was patent. CT: computed tomography; SVG: saphenous vein graft; RCCA: right common carotid artery.
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