1189

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Case

Bilateral Internal Mammary Artery Unreported Cause for an Anterior

Aneurysms: Mediastinal

Report

A Previously Mass

John A. Giles,1 Alan G. Sechtin,1 Mary M. Waybill,1’2 and Richard P. Moser, Jr.1’3

Although

anterior

mediastinal

masses

have

many

causes,

vascular causes are among the most important and must always be excluded. Vascular causes usually include aneurysms of the thoracic aorta, the brachiocephalic arteries, the intercostal

arteries

or, rarely,

of the

We report a case of a 39-year-old mammary

artery

aneurysms,

innominate

[1-6].

woman with bilateral internal

an unusual

our knowledge, previously mediastinal mass.

vein

(and,

unreported)

to the best of

cause for an anterior

On the basis ofcombined underwent

thoracotomy

clinical and radiologic

and

uneventful postoperative Pathologic examination

bilateral

recovery of the

findings, the patient

aneurysmectomy.

She

made

an

and continues on hemodialysis. resected internal mammary artery

aneurysms revealed thrombus formation overlying an eroded, fibrotic vessel wall. Additional findings included loss of elastic tissue and sparse lymphocytic and eosinophilic infiltrates. Although nonspecific, these features are consistent with a healed vasculitis as may be encountered in polyarteritis nodosa.

Discussion For unknown Case Report

remarkably

A 39-year-old woman had cough and hemoptysis of 2 months duration. Her medical history was significant for suspected polyarteritis

nodosa

and

end-stage

renal

disease,

the

latter

diagnosed

histo-

reasons,

resistant

the internal

to typical

mammary

(nontraumatic)

arteries

are

abnormalities.

Previous isolated reports of internal mammary include posttraumatic arteriovenous fistulas,

artery diseases mycotic aneu-

rysms,

atherosclerotic

fibromuscular

hyperplasia

and,

rarely,

ing this earlier workup, chest radiographs were unremarkable. Hemodialysis was begun and, 6 months later, moderate hypertension

disease [2-4]. To the best of our knowledge, there have been no previous reports of bilateral internal mammary artery aneurysms or of diseased internal mammary arteries presenting as a medias-

developed.

tinal mass.

logically

1 year earlier after percutaneous

crescentic

glomerulonephritis

Posteroanterior

and

lateral

and 1 B), obtained during the current of cough and hemoptysis, showed mediastinal

mass

renal biopsy, which showed

and extensive

that had not been

glomerulosclerosis.

chest

radiographs

Dur-

(Figs.

1A

admission for the assessment a well-circumscribed, anterior apparent

on the films obtained

approximately 1 0 months earlier. Further radiologic evaluation of the anterior mediastinal mass included contrast-enhanced CT, which showed that the mass reprosented bilateral internal mammary artery aneurysms (Figs. 1C and 1 D), with a moderate amount of associated peripheral thrombus. Superior venacavography showed normal bronchocephalic veins. An arch aortogram and selective internal mammary angiograms (Figs. 1E and 1 F) clearly showed bilateral fusiform aneurysms of the internal mammary arteries, without evidence of arteriovenous fistula. Received

January

12, 1990;

accepted

February

In this 39-year-old

unlikely

in the absence

echocardiographic

Although

of Internal

3Department

of Radiologic

AJR 154:1189-1190,

June

Medicine,

Penn State

preoperative

of appropriate

history

or laboratory

or

the precise

cause

is favored

of these

remains

vasculitis

disease,

recent onset of hypertension, abnormal level of antiantibody (1:640), and supportive histologic findings.

nuclear This case

of bilateral

represents

an unusual

previously

unreported

because

aneurysms

unclear,

internal

of the underlying

mammary

artery

renal

aneurysms

and, to the best of our knowledge, cause

of an anterior

mediastinal

mass.

2, 1990.

University,

The Milton

S. Hershey

Medical

Pathology, Armed Forces Institute of Pathology, Washington, 1990 0361 -803X/90/1

possible

artery aneurysms included but these were all deemed

findings.

The opinions and assertions contained herein are the private views of the authors and do not reflect the views Department of Defense. 1 Department of Radiology, Penn State University, The Milton S. Hershey Medical Center, Hershey, PA 17033. 2Depament

woman,

causes for the internal mammary trauma, infection, and atheroma,

546-1189

Center,

Hershey,

DC 20306-60000.

of the Department

of the Army

or of the

PA 17033. Address

reprint

requests

to A. P. Moser,

Jr.

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C

D

Fig. 1.-A and B, Posteroanterior (A) and lateral (B) chest radiographs reveal an anterior! superior mediastinai mass with well-defined, lobulated margins. C and D, Contrast-enhanced axial CT scans confirm vascular nature of anterior mediastinal masses and show peripheral thrombus (arrows) associated with bilateral internal mammary artery aneurysms. E and F, Selective digital subtraction anglograms of left (E) and right (F) internal mammary

arteries larger

E

show

bilateral

fusiform

aneurysms,

on left side.

F 4. Shelton ME, Mervyn FB, Virmani

REFERENCES 1. Den

Otter

G, Stam

J. Aneurysm

of internal

mammary

artery.

Thorax

1978;33:526-557 2. Ishikawa T, Brown GR. Traumatic artenovenous fistula of the internal mammary artery.J Trauma 1977;1 7:978-980 3. Sanchez FW, Freeland, PN, Bailey GT, et al.Embolotherapy of a mycotic

pseudoaneurysm disease.

Cardiovasc

of the internal mammary artery in chronic granulomatous Intervent

Radiol

1985;8

:43-45

A. A comparison of morphologic and angiographic findings in long-term internal mammary artery and saphenous vein bypass grafts. JAm Coil Cardiol 1988;1 1:297-307 5. Marmolya G, Yagan A. Computed tornographic diagnosis of left innominate vein aneurysm mimicking an anterior mediastinal mass on pialn films: a case report. J Thorac imaging 1989;4:77-78

6. Glassberg RM, Sussman SK. Life-threatening taneous transthoracic intervention: importance artery.

AJR 1990;150:47-49

hemorrhage

due to percu-

of the internal

mammary