Brachiocephalic pseudoaneurysm and superior vena cava fistula in an adult with a Blalock-Taussig shunt

Excerpt

A 64-year-old male presented with headache. His medical history was remarkable for tetralogy of Fallot that had been repaired using a Blalock-Taussig shunt and later by intracardiac repair. Shortly after admission, he collapsed into a coma, with severe upper body cyanosis, petechia and distended neck veins. Computerized arterial angiography (Fig. 1) revealed a large pseudoaneurysm of the brachiocephalic artery originating from the remnants of the old Blalock-Taussig shunt compressing the superior vena cava and a fistula communicating between the pseudoaneurysm and vena cava. Arterial angiography revealed contrast material leaking from the brachiocephalic artery into the pseudoaneurysm (Fig. 2a) and backward venous filling into the internal jugular veins (Fig. 2b). After exclusion of the fistula by stent graft implantation (Fig. 2c), rapid clinical and angiographic improvement was observed. Head CT showed a large infarct at the right middle cerebral artery territory caused by diminished blood flow into the right MCA due to diversion of blood from the brachiocephalic and carotid arteries into the pseudoaneurysm and SVC. The patient gradually regained consciousness, with left-sided hemiplegia, and was eventually discharged. Sadly, he died 2 months later because of stroke complications.

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