We report a rare case of brachiocephalic arterial aneurysm associated with rapid tracheal obstruction. A 68-year-old woman visited our hospital because of progressive dyspnea. She developed acute respiratory failure and emergency incubation was performed. CT revealed a large brachiocephalic arterial aneurysm causing severe tracheal stenosis by compression. Angiography revealed a saccular aneurysm behind the brachiocephalic artery. It also demonstrated a common trunk of the brachiocephalic and the left common carotid artery. Aneurysmectomy with arterial reconstruction using an 8-mm prosthetic graft was performed while monitoring of regional cerebral oxygen saturation without extracorporeal circulation. The postoperative course was uneventful and there was no postoperative neurological deficit.

Bacillus Calmette-Guérin (BCG) intravesical instillation therapy for bladder cancer is accepted as an effective treatment, and infectious complications are rare. We present a case report on a patient with a common iliac pseudoaneurysm and a recurrent mycotic thoracoabdominal aortic aneurysm, who had a history of previous BCG therapy for bladder cancer. A 64-year-old man underwent emergency graft interposition of the right common iliac artery due to a ruptured pseudoaneurysm. Nine months after initial surgery, a biopsy of the pelvic retroperitoneal collection revealed epithelioid granuloma with caseous necrosis. Ziehl-Neelsen stain and mycobacterial culture were positive for acid-fast bacilli, which was identified as BCG (Tokyo 172). Diagnosis of BCG infection was delayed because of lack of clear clinical evidence of persistent infection. After 6 months of antituberculous chemotherapy the patient underwent resection of the mycotic thoracoabdominal aortic aneurysm and in situ reconstruction with a branched Dacron graft soaked in rifampicin because of its rapid growth. The pathological diagnosis was infectious aneurysm with sclerosis and epithelioid granuloma, however, acid-fast stain and culture were negative. Nine months later CT showed no recurrence of infectious aneurysm. Because the clinical presentation of BCG mycotic aneurysm is different from bacterial or fungal mycotic aneurysm, diagnosis by means of medical history checking and clinical presentation, in addition to surgical and medical combined treatment are important for its management.

A 75-year-old man with a heart murmur and fatigability was referred to our hospital. We diagnosed unruptured giant right sinus of Valsalva aneurysm that obstructed the right ventricular outflow tract by echocardiography (UCG), computed tomography (CT) and magnetic resonance imaging (MRI). The right ventricle was dilated and its ejection fraction was decreased to 9.3% by MRI. Successful surgical repair involved the right sinus of Valsalva plasty using a bovine pericardial patch and resection of the aneurysm through only a right ventricular outflow incision. His postoperative course was uneventful.