Tuberculous septic pseudoaneurysm of the right subclavian artery: A rare case report.

Introduction: Pseudoaneurysm of the right subclavian artery is very rare, and its most serious complication is rupture, which is unpredictable and fatal. Among the infectious causes, tuberculous pseudoaneurysms represent an exceptionally rare but significant subset, arising from the direct invasion of the arterial wall by Mycobacterium tuberculosis.

Case Report: We present the case of a 60-year-old hypertensive male diagnosed with a right subclavian artery septic pseudoaneurysm, which is rare but serious, often resulting from an infection that weakens the arterial wall. Although bacterial infections are the most common etiologies, mycobacterial infections, such as those caused by Mycobacterium tuberculosis, should also be considered in regions with a high prevalence of tuberculosis or in patients with risk factors for this infection. The patient was successfully treated through a cervicotomy and challenging dissection of major neck vessels. A bypass graft between the distal right subclavian artery and the right carotid artery was performed, restoring vascular flow. Postoperative outcomes were favorable, with full recovery at one week and three months follow-up.

Discussion: This case underscores the importance of timely diagnosis and surgical intervention in managing septic pseudoaneurysms, including those of tuberculous origin, to avoid life-threatening complications such as rupture or systemic sepsis. Comprehensive management should include appropriate antimicrobial therapy tailored to the underlying infectious agent to ensure long-term recovery and graft patency.

Conclusion: Early diagnosis is crucial to prevent the potentially life-threatening complications of a right subclavian artery pseudoaneurysm; therefore, this condition should be considered in patients with a history of trauma or infection presenting with a pulsatile supraclavicular mass or unexplained upper limb symptoms.