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Giant mycotic aneurysm of the vertebral artery: a case report

Devender Singh1, Rama K Pinjala, Anirudh K Purohit

  • 1Department of Vascular and Endovascular Surgery and Neurosurgery, Nizam Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India. drdevendersingh@hotmail.com

Journal of Vascular Surgery
|August 17, 2005
PubMed

Insights

Giant mycotic pseudoaneurysms of the vertebral artery are rare and challenging to manage. This case highlights successful surgical excision in a pediatric patient with bacterial endocarditis.

Area of Science:

  • Vascular Surgery
  • Pediatric Cardiology
  • Infectious Diseases

Background:

  • Giant mycotic pseudoaneurysms of the vertebral artery are exceptionally rare, posing significant management challenges due to complex anatomy and proximity to cranial nerves.
  • Bacterial endocarditis is a critical predisposing factor for mycotic aneurysms, necessitating prompt diagnosis and treatment.

Observation:

  • A 7-year-old boy presented with a large (10 x 5 cm) left suboccipital pulsatile swelling, indicative of a prerupture syndrome.
  • Contrast angiography confirmed a pseudoaneurysm originating from the left vertebral artery, with echocardiography revealing tricuspid valve vegetations consistent with bacterial endocarditis.

Findings:

  • A two-step surgical approach, including vertebral artery ligation and aneurysm excision, was successfully performed under antibiotic coverage.
  • Postoperative recovery was uneventful, with no neurological deficits observed and complete resolution of the pseudoaneurysm confirmed by magnetic resonance angiography.

Implications:

  • This case demonstrates the feasibility and effectiveness of surgical management for giant mycotic vertebral artery pseudoaneurysms in pediatric patients.
  • Early recognition and multidisciplinary treatment are crucial for improving outcomes in rare vascular infections.
  • Histopathological examination confirmed the mycotic etiology, underscoring the importance of identifying the infectious source.

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