Asian Cardiovasc Thorac Ann 2006;14:352-353
© 2006 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Traumatic Giant True Aneurysm of the Brachiocephalic Artery
Sai S Oruganti, DM,
Ramesh C Mishra, MCh1
Department of Cardiology
1 Cardio Thoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad, India
For reprint information contact: S Oruganti MD Tel: 91 40 2339 6538 Fax: 91 40 2331 0076 Email: osaisatish{at}yahoo.com, Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad 500 082, Andhra Pradesh, India.
A 36-year-old male who received blunt injury to right side of the chest, presented with right sided chest pain, hoarseness of voice and breathlessness on exertion of 1 year duration, feeble arterial pulses in right upper limb and features of Horner’s syndrome. Chest X-Ray (Figure 1
) showed diffuse homogenous opacity involving most of the right hemi thorax. Three-dimensional reconstruction of magnetic resonance angiogram (3D-MRA) (Figure 2) showed an 18 x 12 cm giant aneurysm of the brachiocephalic artery with normal right common carotid and right subclavian arteries.
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Figure 1. Chest roentgenogram (frontal projection) showing diffuse homogenous opacity occupying major portion of the right hemithorax.
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Figure 2. Three-dimensional reconstruction of magnetic resonance angiogram shows large aneurysm arising from distal portion of brachiocephalic artery. Proximal brachoicephalic (open arrow), right common carotid and subclavian arteries (thin arrows) are normal.
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The aneurysmal sac which was free of adhesions, was excised after disconnecting right subclavian and common carotid arteries from it. Two 8-mm Gortex vascular prostheses were used to connect the right common carotid and subclavian arteries to proximal brachiocephalic trunk and ascending aorta respectively. Post operative 3D-MRA (figure 3) showed total separation of the aneurysm from the brachiocephalic artery and patent Gortex vascular grafts.
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Figure 3. Three-dimensional reconstruction of magnetic resonance angiogram shows total disconnection of aneurysm from brachiocephalic artery and patent vascular grafts to subclavian artery (arrow) and right common carotid artery (curved arrow).
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