Ruptured vertebral artery-origin aneurysm causing mediastinal compression and massive hemothorax in neurofibromatosis type 1.

Neurofibromatosis type 1-associated vasculopathy is uncommon but may result in catastrophic arterial rupture. We report a life-threatening presentation successfully managed with emergency endovascular exclusion. A 44-year-old woman with known neurofibromatosis type 1 presented with acute chest pain, dyspnea, and dysphonia. Computed tomography angiography revealed a 23-mm ruptured aneurysm arising from the ostium of the left vertebral artery that was associated with hemomediastinum, airway displacement, and massive hemothorax. Emergency endovascular repair using covered stent-grafts achieved complete aneurysm exclusion while preserving vertebral artery patency. Thoracic drainage was required. The postoperative course was uneventful without any neurologic deficit.