An unusual etiology of a subclavian artery aneurysm

Abstract

A 22-year-old woman presented with a 3-month history of a pulsatile swelling in the right supraclavicular region. A CT angiogram revealed an aneurysm arising from the distal right subclavian artery. At surgery, the subclavian artery was almost entirely replaced by a well-vascularized tumor mass. The vascular tumor along with the native vessel was excised and replaced with a vascular prosthesis. Biopsy was suggestive of an epithelioid hemangioma (EH). In conclusion, an EH is a rare vascular tumor. The presence of vascular hyperplasia with plump endothelial cells protruding into the lumen is the most important discriminator in establishing the diagnosis of EH. Vascular neoplasms presenting as aneurysms should be considered, especially if other etiologies can be excluded.

Epithelioid hemangioma of brachial artery: report of a case and review of the literature

“…About 22 cases have been reported, involving in order of decreasing frequency: temporal artery [14–20], radial artery [21–24], brachial artery [11, 12], ulnar artery [25, 26], axillary artery [27, 28], subclavian artery [29], facial artery [30], post-auricular artery [31], popliteal artery [32], common carotid artery [33] and occipital artery [12]. The lesion can grow entirely in the lumen of the blood vessel developing occlusive symptoms (such as weakening of the pulse in peripheral arteries) or it can originate from the vascular wall and developing outside with compression of adjacent structures.…”

Epithelioid Hemangioma Of The Ulnar Artery

“…3 Given the rarity of this lesion when it involves large arteries, there is no clear consensus as to the optimal operative approach. In the case reported by Selvaraj and colleagues involving the subclavian artery, a polytetrafluoroethylene graft was used to reconstruct the artery following excision of the tumor, 1 and in the case reported by Bhat and colleagues involving the axillary artery, a reversed saphenous vein graft was used following tumor excision. 2 In retrospect, the solid component seen on the ultrasound scan (see Figure 1) is more suggestive of a vascular tumor rather than an aneurysm.…”

“…Rare cases arise from a large vessel, as in this case. 1,2 Regional lymphadenopathy and blood esosinophilia can occur. This suggests an infective agent, but none has been identified.…”