• Images in cardiology

A 26 year old woman with Marfan's syndrome presented with right sided neck discomfort and buzzing, but without neurological symptoms. A pulsatile swelling was palpable above the right clavicle.

The patient had previously had a dissecting aneurysm of the ascending aorta at the age of 15 years, for which her aortic valve and ascending aorta had been replaced with a Bjork-Shiley prosthetic valve and Dacron graft. At the age of 19 she had graft replacement of her descending thoracic aorta, distal to the left subclavian artery, for a further dissecting aneurysm.

Gadolinium enhanced magnetic resonance angiography showed localised fusiform aneurysms, maximum diameter 23 mm, close to the origins of both right and left subclavian arteries (right). There was also evidence of stenosis of both right and left subclavian arteries distal to each aneurysm, the left sided stenosis being more severe than that on the right. Both vertebral arteries originated from the aneurysmal subclavian artery segments. No dissection of the aortic arch or its branches was seen.

This unusual pattern of arteriopathy, apparently associated with Marfan's disease, with almost symmetric dilatation and stenosis of both subclavian arteries, has not, as far as we know, been reported previously.