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- Title
Subclavian Artery Mycotic Aneurysm Associated with Congenital Cervical Rib.
- Authors
Blebea, Catherine A.; Constantinou, Constantinos; Blebea, John
- Abstract
INTRODUCTION Mycotic aneurysmal disease involving the subclavian artery is a rare entity that requires treatment to prevent rupture and hemorrhage. CASE REPORT A 45 year old female presented with a painful pulsatile left supraclavicular mass and brachial plexopathy one month after an episode of nasal cellulitis. Computed tomography with angiography and duplex ultrasound diagnosed a subclavian artery aneurysm in association with a prominent congenital cervical rib. At surgery, pus was found to involve the wall of the artery and surrounding soft-tissue with later culture identification of Streptococcus pneumoniae. The infected aneurysmal portion of the artery was excised and the proximal and distal subclavian artery ligated. Her pain and pressure symptoms resolved immediately after surgery. Satisfactory collateral perfusion was present to prevent development of ischemic symptoms in the arm. LITERATURE REVIEW We identified a total of forty-two other cases previously reported in the English literature in the modern era. It was more prominent in men as compared to females and was diagnosed at an average age of 41 years. The most frequent etiologic bacterial agent was S. aureus. Ligation with excision was the most common surgical treatment employed with good results. Endovascular intervention has been described with coils and covered stents but this does not eliminate the infectious focus and reported follow-up has been of short duration. CONCLUSIONS Although rare, subclavian mycotic aneurysms should be included in the differential diagnosis of patients with supraclavicular or radiating pain and a pulsatile mass especially in the setting of remote infection and the presence of a cervical rib. Ligation with aneurysmectomy, in conjunction with culture-specific antibiotics, is the appropriate therapy with good results.
- Publication
Journal of Surgical Radiology, 2011, Vol 2, Issue 2, p146
- ISSN
2156-213X
- Publication type
Academic Journal