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Case Reports
. 2024 Dec 13;16(12):e75638.
doi: 10.7759/cureus.75638. eCollection 2024 Dec.

Tuberculous Subclavian Artery Pseudoaneurysm in a Young Male With Hemoptysis

Ana Raquel Soares  1 , Sofia Eusébio  1 , Pedro Fiúza  1 , Tiago Pack  1 , Tiago F Ribeiro  2
Affiliations
Case Reports

Tuberculous Subclavian Artery Pseudoaneurysm in a Young Male With Hemoptysis

Ana Raquel Soares et al. Cureus. .

Abstract

Subclavian artery pseudoaneurysms (SAPs) are rare and most often secondary to trauma. On the contrary, a mycotic origin is exceedingly rare, and defining this etiology can become challenging. We present a rare case of a tuberculous SAP in a young patient. A 19-year-old male patient with no past medical history and no relevant epidemiological context presented to the ED with three-day left pleuritic thoracalgia and hemoptysis. A chest roentgenogram revealed a left paratracheal opacity, and a CT angiography revealed a voluminous left SAP. Accordingly, endovascular surgical treatment of the SAP was performed, with complete symptom remission. Although mycotic etiology was suspected, the first microbiological assays were negative. Following six months asymptomatic, hemoptysis recurred, and a bronchoscopy was performed. Mycobacterial cultures of bronchoalveolar lavage were positive for Mycobacterium tuberculosis, and tuberculous left SAP and pulmonary tuberculosis were ultimately confirmed. Treatment with first-line anti-tuberculosis drugs was completed without associated complications and with symptom resolution. This case highlights that in the presence of a non-traumatic arterial pseudoaneurysm, the diagnosis of tuberculosis should always be considered and carefully investigated. An approach with a combination of anti-tuberculous therapy and surgery seems the most appropriate in these cases. When endovascular treatment is performed, follow-up must be maintained to exclude future complications, particularly those related to possible infection of the prosthetic vascular material.

Keywords: aneurysm; hemoptysis; mycotic pseudoaneurysm; subclavian artery; tuberculosis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Left paratracheal opacity on chest roentgenogram (white arrow)
Figure 2
Figure 2. CT angiography revealing left subclavian artery pseudoaneurysm (white arrows)
(A) Axial view and (B) sagittal view
Figure 3
Figure 3. CT angiography depicting patent stent-graft covering subclavian pseudoaneurysm (white arrow)
Three-dimensional volume-rendering reconstruction
Figure 4
Figure 4. CT revealing residual lung densifications in the left upper lobe and the inner segment of the middle lobe (white arrows)
Axial view
See this image and copyright information in PMC

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