Bilateral Aneurysms of the Subclavian and Axillary Arteries

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Abstract
The following case of bilateral aneurysms of the subclavian and axillary arteries is unique in the authors' experience, nor were they able to find any similar example in the literature. Case Report A white male, 14 years of age on his admission, Feb. 16, 1950, to the cardiovascular service, complained of headaches and blurring of vision of approximately two months duration. He had previously been in good health. The headaches were gradual in onset and bilaterally frontal and supraorbital in position. They had become increasingly severe and frequent and seemed to be aggravated by exertion. The patient stated that just prior to admission he would awaken in the morning with headache, occasionally improving on arising. Blurring of vision had been noted only on reading fine print. There were no other symptoms and the review of systems contributed no further information. There was no history of vertigo, nausea, or vomiting. The past history revealed an uncomplicated tonsillectomy at seven years of age. There had been occasional enuresis. Urine studies six years earlier were negative, and this complaint apparently subsided. In 1946, the patient was in a hospital for twelve days for a blood clot said to involve the left forearm. The symptoms were pain, paresthesia, and coldness of the left hand, with no loss of function. The condition was treated with a heat cradle to the arm, and there was no residuum. There was a history of occasional headaches earlier, for which glasses were prescribed in 1948. In December 1949, examination by a school physician revealed a hypertension, and the patient was hospitalized for eleven days from Jan. 15, 1950, for study. The patient did not use tobacco but drank an occasional glass of wine and took two cups of coffee daily. He made fair grades in high school. Four sisters and three brothers were living and well. His father was fifty-five years of age, with a history of bronchial asthma. His mother was fifty years of age and diabetic. Physical examination revealed a well developed and well nourished youth of Italian descent. His height was 65 inches and weight 120 pounds. The pulse was 80 and the oral temperature was 99° F. The blood pressure was 138/68 on the right; on the left it was 100/? by palpation, with no pressure reading obtainable by auscultation. The eyegrounds were considered normal. The cardiac apical impulse was forceful. The radial and brachial pulses were strong and normal on the right but markedly diminished on the left. There was a loud bruit and thrill on the right side of the neck and beneath the right clavicle. Blood pressures in the legs were 170/90 right and 160/90 left. Laboratory studies were not remarkable. An electrocardiogram and a chest roentgenogram (Fig. 1) were normal. The Kahn test was negative. The urine was acid, negative for albumin and sugar and microscopically, with a specific gravity of 1.020.

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