Recurrent ischemic events in the setting of posterior circumflex humeral artery aneurysm in an athletic young adult: a case report with diagnostic pitfalls

Posterior circumflex humeral artery (PCHA) aneurysm is a rare condition, often affecting young professional overhead sports athletes, such as volleyball or baseball players. This condition is one of the manifestations of quadrilateral space syndrome (QSS). We present the case of a 20-year-old former basketball player and recreational swimmer, currently a member of the national team in precision flying, who developed recurrent symptoms of digital ischemia due to a PCHA aneurysm. Despite undergoing computed tomography (CT) imaging, the aneurysm was initially not identified, which delayed proper diagnosis. The patient ultimately underwent surgical treatment, leading to successful resolution of symptoms and return to physical activity. This case underscores the diagnostic challenges of PCHA aneurysm, especially in athletes presenting with unexplained digital ischemia, and emphasizes the need for awareness of this condition among sports medicine and vascular specialists.