Tortuous Innominate Arteries Simulating Aneurysms

THE PURPOSE of this presentation is to review the clinical picture of the seemingly expansile supraclavicular or superior mediastinal pulsating mass. While to physical examination or chest fluoroscopy, pulsating masses may seem to be aneurysmal, aneurysms in the innominate-carotid-subclavian vessels are rare.1,2In this area aneurysmectomy carries a high morbidity and mortality. Occasionally all doubt of diagnosis is removed by visible or palpable aneurysmal bone erosion in the area of the clavicle or upper sternum. More often, careful palpation reveals a tortuous course of one of the large arteries of the area which accounts for the swelling and establishes a diagnosis (Fig 1). In the group between these extremes definite diagnosis by physical examination is impossible because of the heavy skeleto-muscular structures shielding the area. Angiography to confirm aneurysm becomes mandatory. By clinical or fluoroscopic examination, each of the following patients was thought to have an innominate aneurysm. Each