Urgent cardiopulmonary bypass for the management of intrabronchial descending aortic aneurysm rupture

Introduction Mycotic thoracic aneurysms in children are rare and carry high mortality, particularly when complicated by erosion into adjacent pulmonary structures. Early recognition and surgical intervention are essential to prevent catastrophic outcomes. Case Report A 14-year-old presented with respiratory symptoms. Imaging revealed a large mycotic aneurysm of the aorta with compression of multiple mediastinal structures. During induction of anaesthesia, aneurysm rupture caused haemoptysis and hypovolemic arrest. Emergent femoral cannulation enabled initiation of cardiopulmonary bypass and novel use of endotracheal suction with autologous cell salvage facilitated surgical exposure and successful aneurysm repair. Discussion Thoracic mycotic aneurysms present diagnostic complexity and potential catastrophic outcomes. In this patient, rapid multidisciplinary coordination, dual-arterial cannulation and intraoperative blood-salvage techniques proved critical to restoring circulation and achieving surgical control. Conclusion Thoracic mycotic aneurysms in children require extreme vigilance and adaptable surgical strategies. This case demonstrates that survival is possible with innovative management in the face of life-threatening complications.