Idiopathic internal mammary artery aneurysm in the setting of aberrant right subclavian artery

Abstract

Aneurysms of the internal mammary artery are extremely rare. Immediate treatment is necessary because of the high risk of rupture that can be life-threatening. Here we describe a case of idiopathic internal mammary artery aneurysm in a 54-year-old woman in the setting of aberrant right subclavian artery. The aneurysm was successfully treated with coil embolization without complications.

Successful treatment of a right internal mammary artery aneurysm with thoracoscopic surgery

“…The IMA is one of the arteries that branches from the subclavian artery, runs behind the sternum, and has a normal diameter of approximately 2 mm. An IMA aneurysm is rarely seen outside of conditions such as physical trauma, hereditary diseases, or iatrogenic problems 1, 2, 3, 4, 12, 13, 14. Only 10 cases of an IMA aneurysm outside of the conditions described above have been reported since 1978 (Table) with a mean patient age of 51.9 years at occurrence, irrespective of sex or laterality.…”

“…From a pathologic viewpoint, an IMA aneurysm is most commonly caused by atherosclerosis,11, 15, 16 and either degeneration of the tunica media or arterial fibromuscular dysplasia is associated with its occurrence 1, 10TablePreviously reported internal mammary artery aneurysmStudySex/locationEtiologyTreatmentOutcomeOtter 9 (1978)Female/LIMAUnknownExploratory thoracotomy and ligationUneventful recoveryWildhirt 15 (1994)Female/RIMAAtherosclerosisOpen ligation and resectionUneventful recoveryChan 6 (1994)Female/LIMAUnknownAngiographic embolizationUneventful recoveryConney 10 (1995)Male/RIMAArterial fibromuscular dysplasiaDivision of IMAUneventful recoveryTabata 11 (1995)Male/RIMAAtherosclerosisRoot ligationUneventful recoveryKugai 16 (1999)Male/LIMAAtherosclerosisITA aneurysmectomy and reconstructionUneventful recoveryOkura 1 (2012)Female/RIMACystic medial degenerationOpen ligation and resectionUneventful recoveryLindblom 2 (2013)Male/LIMAUnknownEndovascular coilingUneventful recoveryHeyn 3 (2014)Male/LIMAThrombotic obliterated aneurysmOpen surgical resectionUneventful recoveryAlmerey 4 (2017)Female/RIMAUnknownCoil embolizationUneventful recoveryPresent case (2013)Female/RIMAdissectionThoracoscopic ITA resectionUneventful recovery IMA, internal mammary artery; ITA , internal thoracic artery; LIMA, left internal mammary artery; RIMA, right internal mammary artery.…”

“…Rupture of an internal mammary artery (IMA) aneurysm is a life-threatening condition1, 2, 3, 4 that causes massive hemothorax or hemorrhagic shock,2, 5, 6 can lead to death, 7 and requires immediate treatment 3, 4, 8. An IMA aneurysm is often discovered accidentally on chest radiographic examinations performed for other diseases1, 3, 9, 10, 11 and is currently detected most often on chest computed tomography (CT) angiography.…”

Tratamento endovascular de aneurisma de artéria torácica interna esquerda

“…5 Presentation of ITAAs can be variable, with findings such as anterior mediastinal mass, hemothorax, or hemoptysis, but they may also be asymptomatic and found incidentally. 6 While ITAAs are small, rupture can be fatal and the most common initial manifestation is hemothorax with hypovolemic shock. 7 Diagnosis is generally founded on the classic "coin lesion" finding seen on simple chest X-rays or on presence of a mass in the anterior mediastinum observed on computed tomography of the thorax.…”

“…8 Angiotomography can be used to study the aneurysm in detail, which is important for planning treatment. 6 The treatment options for pseudoaneurysms and true aneurysms are the same. 4 Minimally invasive treatment using endovascular techniques with coil embolization or stenting has become the first choice option for treatment of smaller aneurysms.…”