Combined Surgical Management and Endovascular Repair of Aortic Arch Mycotic Pseudoaneurysm Secondary to Descending Necrotizing Mediastinitis

Descending necrotizing mediastinitis is a life-threatening infection, and in extremely rare instances it can erode into the aortic wall and lead to mycotic pseudoaneurysms. A 50-year-old man presented with chest pain, hoarseness, and dysphagia. Imaging revealed an aortic arch pseudoaneurysm and a mediastinal abscess containing multidrug-resistant <i>Salmonella.</i> Urgent surgical repair using deep hypothermic circulatory arrest allowed thorough debridement and patch closure. Two months later, suture line dehiscence was successfully managed by thoracic endovascular aortic repair. He recovered under prolonged antibiotic therapy. This case underscores the importance of early recognition and a multidisciplinary, staged approach to overcome both immediate and delayed complications.