Giant mycotic aneurysm of the vertebral artery: A case report

Giant mycotic pseudoaneurysms of the vertebral artery are extremely rare. Their management is technically challenging because of the distorted anatomy and intimate relation to the lower cranial nerves. We present a rare case of a 7-year-old boy referred to us by a pediatrician who was treating him for bacterial endocarditis. The pulsatile swelling measured 10 × 5 cm and was located in the left suboccipital triangle. The skin over the swelling was tethered to the underlying pulsatile swelling, suggesting prerupture syndrome. A contrast angiogram revealed a pseudoaneurysm from the third part of the left vertebral artery. Vegetations were seen on the tricuspid valve on echocardiography. Two-step surgery was performed under the cover of antibiotics. Excision of the aneurysm was done after ligation of the third part of the vertebral artery. The postoperative period was uneventful, and there was no neurologic deficit. Repeat magnetic resonance angiogram revealed no residual pseudoaneurysm. The histopathologic examination of the specimen was suggestive of mycotic aneurysm of left vertebral artery.