Tuberculous Subclavian Artery Pseudoaneurysm in a Young Male With Hemoptysis

Subclavian artery pseudoaneurysms (SAPs) are rare and most often secondary to trauma. On the contrary, a mycotic origin is exceedingly rare, and defining this etiology can become challenging. We present a rare case of a tuberculous SAP in a young patient. A 19-year-old male patient with no past medical history and no relevant epidemiological context presented to the ED with three-day left pleuritic thoracalgia and hemoptysis. A chest roentgenogram revealed a left paratracheal opacity, and a CT angiography revealed a voluminous left SAP. Accordingly, endovascular surgical treatment of the SAP was performed, with complete symptom remission. Although mycotic etiology was suspected, the first microbiological assays were negative. Following six months asymptomatic, hemoptysis recurred, and a bronchoscopy was performed. Mycobacterial cultures of bronchoalveolar lavage were positive for Mycobacterium tuberculosis, and tuberculous left SAP and pulmonary tuberculosis were ultimately confirmed. Treatment with first-line anti-tuberculosis drugs was completed without associated complications and with symptom resolution. This case highlights that in the presence of a non-traumatic arterial pseudoaneurysm, the diagnosis of tuberculosis should always be considered and carefully investigated. An approach with a combination of anti-tuberculous therapy and surgery seems the most appropriate in these cases. When endovascular treatment is performed, follow-up must be maintained to exclude future complications, particularly those related to possible infection of the prosthetic vascular material.