A 74-year-old man was referred to our hospital due to chest X-ray abnormalities. He had been treated with antihypertensive drugs. A physical examination showed a blood pressure of 164/86 mmHg and subclavian subcutaneous swelling with some distended superficial veins (Picture A, arrows indicate distended superficial veins). He had no symptom of recurrent nerve paralysis. The patient's chest X-ray findings showed dilated mediastinum and aortic arch. Computed tomography revealed a 65-mm thoracic aortic aneurysm (TAA) with stenosis of the innominate vein (Picture B, arrow indicate stenosis of innominate vein). Surgery was recommended but rejected by the patient. Three months later, he re-visited our hospital by ambulance due to shock status. Computed tomography revealed a ruptured TAA (Picture C). Emergency surgery was performed. The swelling had not been caused by the TAA itself but by the mass of collateral veins formed by the innominate venous stenosis due to the TAA. Subclavian subcutaneous swelling with same-side superficial collateral veins may be a predictive sign of a large TAA.
Picture.
The authors state that they have no Conflict of Interest (COI).