localized balloon - like bulge in an artery wall is called aneurysm that classified as true , pseudo , and mycotic types . true aneurysm is the localized dilation involving all three layers ( intima , media , and adventitia ) of the arterial wall , but a false type or pseudoaneurysm is a collection of flowing blood that communicates with the arterial lumen and is filled only by the adventitia or surrounding soft tissue ( 1 ) . aneurysms can manifest in all arteries but peripheral artery aneurysms in the upper extremities are rare so that brachial artery aneurysms have an overall prevalence of 0.5% ( 2 - 4 ) . also , mycotic and post - traumatic are more common than true aneurysm ( 3 , 5 ) . there are few reports in this regard and the following presentation described a patient referred to the emergency department ( ed ) with signs and symptoms of arterial insufficiency and final diagnosis of brachial artery aneurysm . a 52-year - old male referred to the ed with complaining of sudden onset and progressive pain with coldness of his right upper extremity when he was brushing . the subject had no other complaint such as chest pain , palpitation , or shortness of breathing . he had no history of trauma , injection , dialysis , arteriography , intravenous drug abuse , or surgery in his right upper extremity . the patient s history was negative regarding hypertension , ischemic heart diseases , diabetes mellitus , hyperlipidemia , etc . on physical examination , he had a swelling on his right axilla without pigmentation . palpation revealed a 2  2.5 centimetre pulsatile , compressible mass with no tenderness and the temperature equal to the surrounding skin . supraclavicular and axillary lymph nodes were not bilaterally palpable . pulse of the axillary artery was palpable , but brachial and radial arteries were pulseless . the capillary refill time was in normal range and sensory and motor functions were intact . cardiac examination revealed no murmurs , lungs sounded clear , and abdomen was soft with no tenderness . paraclinic investigation showed 6800/mm white blood cell ( wbc ) count , 14gram / decilitre haemoglobin level , 13 millimetres / hour erythrocyte sedimentation rate ( esr ) , 13 seconds prothrombin time ( pt ) , and 33 seconds partial thromboplastin time ( ptt ) . color doppler ultrasonography of right upper extremity arteries showed an anechoic , pulsatile , 25  22 millimetres mass with turbulent flow seen along the brachial artery . computed tomoangiography showed an aneurysm of the proximal right brachial artery associated with arterial occlusion in distal radial branch ( figures 1 and 2 ) . embolectomy was done , the aneurysm resected , and the brachial artery successfully re - vascularised by interposing a saphenous vein graft . finally , the patient was discharged , under warfarin anticoagulation therapy , without any complication on the fifth days after surgery . three - dimensional computed tomoangiography of the proximal right brachial artery , white arrow shows the location of aneurysm . the usual manifestation of peripheral aneurism is incidentally finding of a pulsatile , painless and asymptomatic mass , which becomes symptomatic when complications arise . thrombosis in the sac , vascular collapse which throws emboli into peripheral circulation , and also disruption caused the profuse bleeding are among these complications ( 5 ) . atherosclerotic aneurysms , which commonly develop in advanced ages , are often seen in large arteries , while pseudoaneurysm may be observed in any location and age . aneurysms are generally revealed in infrequent locations due to marfan s syndrome , syphilis , and major trauma . familial history of aneurysm , connective tissue disorders , and atherosclerotic risk factors ( hypertension , hyperlipidemia , smoking , and age ) are considered as it s risk factors ( 1 , 4 , 6 ) . without proper management , hemorrhage , extremity venous edema , cutaneous erosion , and especially adjacent neurological structure compression can develop due to enlargement of the aneurysm . the first symptom of upper extremity aneurysms can be nerve injury due to adjacent nerve compression ( 2 ) . prompt diagnosis and treatment of true peripheral artery aneurysms are necessary to minimize the complication rate and serious long - term squeal ( 7 , 8) . differential diagnosis include pulsating tumours ( such as bone sarcoma , osteoclastoma ) , arterio - venous malformation , lymphadenopathy , lipoma , hematoma , and abscess . the diagnosis should be confirmed by a duplex ultrasonography , show the arterial blood flow into the aneurysm . computed tomography or magnetic resonance angiography can also be used for diagnosis ( 9 ) . in spite of all above - mentioned however , the first choices in investigation are often color doppler ultrasonography and subtraction image angiography ( 2 ) . the defect in the artery is usually small and easily identified by a transient release of the proximal clamp ( 5 ) . close observation , thrombin injection , ultrasound - guided compression , and operative repair are treatment options . aneurysms of the brachial artery are not common , but could be potentially limb threatening . all authors passed four criteria for authorship contribution based on recommendations of the international committee of medical journal editors .
brachial artery aneurysms are rare but potentially limb threatening condition . the presented case here is a 52-year old male referred to the emergency department complaining a sudden onset and progressive pain with coldness of his right upper extremity during brushing . 
 the right upper extremity was pulseless and three - dimensional computed tomography showed an aneurysm of the proximal right brachial artery associated with arterial occlusion in its distal branch . 
 embolectomy was done , the aneurysm resected , and the artery successfully re - vascularised by interposing a saphenous vein graft .