Aneurysm of the axillary artery in a child with tuberous sclerosis

Tuberous sclerosis is an autosomal dominant, chronic progredient disorder of multiple organ systems, especially of the CNS, due to a malfunction of cellular differentiation and proliferation. We report on the complication of a large aneurysm of the axillary artery in a patient with tuberous sclerosis. Case report: The five year old boy was presented with a large swelling below the right clavicula for three weeks. By ultrasonography, arterial malformation was assumed. The patient was seizure-free on antiepileptic drugs. Doppler ultrasonography, arterial angiography and MR angiography revealed a large aneurysm of right axillary artery (6×3,5–4cm). Clinical hemodynamic parameters were not significantly influenced. Other clinically relevant aneurysms could be excluded. After interdisciplinary discussion we decided to resect the aneurysm in respect of the risk of bleeding. The postoperative MRI showed a good surgical result with slight local irregularities of axillary artery. Discussion: Based on multimodal pre-operative diagnostics our patient was treated surgically without complications. Generally, aneurysms are known as a rare disorder in children, but are described in patients with tuberous sclerosis without information about the incidence in children. In the long-term follow-up of patients with TS the risk of variable vascular dysplasias and their life-threatening bleeding complications should be considered.