Subclavian aneurysm presenting with massive hemoptysis: a case report and review of the literature.
We present a case of a 70-year-old male with a past medical history of coronary artery bypass grafting and end stage renal disease who presented with massive hemoptysis. He had a history of methicillin-resistant Staphylococcus aureus endocarditis, with infection and removal of endocardial pacing leads. His work-up revealed a 2.9-cm proximal left subclavian artery aneurysm. Bronchoscopy confirmed bright red blood in the left upper lobe bronchus and coronary angiography confirmed a patent left internal mammary artery (LIMA) to left anterior descending bypass. Because of the consideration of maintaining coronary perfusion via the LIMA while excluding the subclavian aneurysm, he underwent a left carotid to left axillary artery bypass graft followed by deployment of an Amplatzer II vascular plug just distal to the aneurysm. A thoracic endograft was then deployed to exclude the origin of the subclavian. A review of the literature reveals hemoptysis as a rare presentation of a subclavian aneurysm. We discuss approaches to this challenging clinical problem, ranging from open repair to hybrid approaches.
Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut.
Hilary A
HA
Brown
Department of Interventional Radiology, Yale University School of Medicine, New Haven, Connecticut.
John E
JE
Aruny
Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
John A
JA
Elefteriades
Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut.
Bauer E
BE
Sumpio
aneurysm; endovascular repair; hemoptysis; hybrid; subclavian