Images in vascular medicine Multiple arterial aneurysms in the mediastinum

A 37-year-old woman presented with a 5-month history of hoarseness. She had no other clinically significant medical history or history of trauma. An ENT doctor diag-nosed swelling of the right vocal chord. With the hoarse-ness being refractory to medical treatment, a chest com-puted tomography (CT) scan was performed which revealed distinct elongation and kinking of the bronchial arteries with multiple aneurysms near the right subcla-vian artery in a location that could cause compression of the recurrent laryngeal nerve (Panel A: posterior view). A contrast-enhanced whole-body magnetic reso-nance angiography ruled out intracranial, abdominal or acral aneurysm formation (Panel B). Given the uncertain origin of the aneurysms, selective angiography of the thoracic aorta and the supra-aortic vessels showed a total of five aneurysms along the aortic arch (Panel C): aneurysms numbers 1 and 3 were supplied from a bron-chial artery and the right internal thoracic artery; aneur-ysms numbers 4 and 5 were found to originate from the right and the left subclavian artery respectively; aneu-rysm number 2 originated from the brachiocephalic trunk. Considering the high risk of massive bleeding and neu-rologic injury with open surgical treatment, we decided to proceed with endovascular embolization. All five aneur-ysms were selectively embolized in two consecutive ses-sions using interlocking detachable coils (IDC; Boston Sci