Spontaneous innominate artery perforation presenting as hemoptysis

An 86-year-old man with a history of asthma and hypertension suddenly developed hemoptysis. A computed tomographic (CT) scan demonstrated a right-sided paratracheal mass adjacent to the aortic arch that had not been recognized on a CT scan 5 months before. Angiography revealed extravasation of the contrast agent from the innominate artery. These findings suggested innominate artery perforation resulting in a pseudoaneurysm. At the time of operation, an approximately 3-cm defect was noted at the right side of the innominate artery. The aneurysmal cavity was inspected through the tear of the innominate artery, and there was no purulent fluid or thrombus. A prosthetic graft interposition between the origin of the innominate artery and the bifurcation of the common carotid artery and subclavian artery was performed under cardiopulmonary bypass. Histologic study of the innominate artery revealed only atherosclerotic changes. There was no evidence of infection or malignancy. The hemoptysis disappeared postoperatively.