Traumatic pseudoaneurysm of the brachiocephalic artery obstructing the airways

This is a case report of a young patient referred to our ER as a case of mediastinal tumor compressing the airways. On presentation, the patient had severe stridor and tachypnea, with oxygen saturation less than 60%. As the patient presented alone to the ER, obtaining any history was not possible. Chest x-ray showed a huge right paratracheal mediastinal mass compressing the airway. The patient was not able to lie supine and was taken to the OR for intubation under fiberoptic bronchoscopy guidance. Bronchoscopic evaluation showed significant compression of the trachea from the right side. A small endotracheal tube (size 5) was successfully inserted. Then, the patient was taken for a chest CT with IV contrast. Chest CT showed a huge vascular mass compressing the trachea, the right mainstem bronchus, and the superior vena cava. The study showed the proximal innominate artery, followed by a pseudoaneurysm. There was an interruption of the right subclavian artery at its origin. Collaterals were seen supplying the right upper limb. Surgical resection was done. Postoperatively the patient gave a history of chest-penetrating injury in the right infraclavicular area, 15 years prior to presentation. The pseudoaneurysm of the innominate artery is a rare delayed complication of chest trauma.