Giant True Aneurysm of the Left Subclavian Artery
A 63-year-old man was referred for evaluation of an abnormal mediastinal contour on chest film, first documented 4 years earlier (Figure 1). The patient had no history of arteritis and no chest symptoms, but he did suffer chest trauma in a car accident 30 years earlier. He also consumed 1 pack of cigarettes per day. Physical examination was unremarkable except for a blood pressure difference between arms (right arm: 160/90 mm Hg; left arm: 140/80 mm Hg). Coronary angiography revealed aneurysmatic coronary heart disease but no critical epicardial stenoses. Three-dimensional reconstruction of a magnetic resonance angiogram with gadolinium-diethyl-enetriamine pentaacetic acid (DTPA) infusion (Figure 2) showed a dextroposition of the proximal descending aorta and a giant aneurysm of the left subclavian artery, just beyond its aortic ostium, that measured 70×80 mm in diameter. Because of the risk of rupture, the aneurysm was surgically excised using a traditional open approach without transverse aortic clamping (Figure 3). The operation was completed by interposition of a 8 mm Goretex vascular prosthesis between the aorta and the mid-portion of the left subclavian artery. Histopathological examination disclosed an atherosclerotic, true aneurysm with partial calcifications and layers of wall-adhesive thrombotic material. Two months after surgery, the patient is doing well but is in logopedic therapy for slight hoarseness as a result of intraoperative injury of the left nervus laryngeus recurrens.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.