PMC5864521_01
Pre-operative CT angiography showing a partially thrombosed aneurysm (A) of the right subclavian artery (S) with air lucencies and severe inflammatory changes. Also, a thrombus (arrow) is seen in the subclavian artery, directly distal to the aneurysm. Edematous subcutaneous tissue of the right chest wall, right axial, and right neck root as well as right shoulder muscles. CT, computed tomography.
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Further diagnostics now using a computed tomography (CT) angiography showed a 3.5 x 2.9 cm mycotic aneurysm of the intrathoracic right subclavian artery (RSA) beginning 2 cm distal to the offspring from the brachiocephalic trunk ending at the level of the thoracic outlet uncompressing the offspring of the right vertebral artery and the right internal mammary artery ( Fig. 1 ).
Intraoperative situs before opening of the abscess formation (
A
). Intraoperative situs after neopericardial tube graft insertion (
B
).
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RSA was completely destructed by the infective process, and discontinuity at the level of the right vertebral artery offspring could be observed ( Fig. 2 ). Remaining back bleeding from the RSA was controlled via a Fogarty catheter.
Reconstructed postoperative CT angiography images showing the reconstructed right subclavian artery with regression of the air lucencies and patent subclavian artery with good distal run off. Arrow: proximal anastomosis, Arrow head: distal anastomosis. CT, computed tomography.
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Completion CT scan showed regular arterial perfusion of the right upper extremity and a regular situs without any remaining signs of remaining or recurring infection ( Fig. 3 ).