# Anesthetic Challenges in a Patient With an Expanding Recurrent Mycotic Pseudoaneurysm of the Right Brachiocephalic Artery: A Case Report and Literature Review

## TL;DR

This case report discusses the anesthetic and airway challenges in a patient with a life-threatening pseudoaneurysm and highlights the importance of timely intervention and teamwork.

## Contribution

The paper presents a rare case of a mycotic pseudoaneurysm with airway complications and emphasizes tailored anesthetic strategies.

## Key findings

- Successful endotracheal intubation was achieved using video-laryngoscopy in a high-risk patient.
- Prompt surgical repair and postoperative care led to a successful outcome.
- The case underscores the need for early diagnosis and multidisciplinary collaboration in managing such conditions.

## Abstract

Airway obstruction requires urgent intervention. When dealing with the right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care.

We describe the clinical case of a 38-year-old male patient who presented with a large recurrent right brachiocephalic artery pseudoaneurysm associated with tracheal compression. The patient required urgent surgical intervention due to the pseudoaneurysm's enlargement and progressive respiratory distress. Awake fiber-optic intubation was not feasible. A cardiopulmonary bypass was kept on standby in the event of failed intubation and ventilation, or circulatory collapse.

Endotracheal intubation was performed successfully using a video-laryngoscopy. After successful surgical repair of the pseudoaneurysm, the patient was transferred to ICU where he was extubated 48 hours post-surgery, following treatment with methylprednisolone for edematous aryepiglottic folds identified during video-laryngoscopy.

Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes. In our work, we also provide a summary of the reported similar cases.