A Rare Case of Innominate Artery Compression Syndrome in an Elderly Patient

A BSTRACT Innominate Artery Compression Syndrome (IACS) is a well-recognized but rare cause of tracheal obstruction, classically described in infants and young children. Its occurrence in elderly patients is exceptionally uncommon, with only isolated case reports documented in the literature. We report the case of a 69-year-old female with a background of cervical spondylotic myelopathy managed surgically, type 2 diabetes mellitus, and recurrent lower respiratory tract infections, who presented with progressive dyspnea and wheezing. Computed tomography of the thorax revealed 50% tracheal luminal narrowing secondary to a tortuous, ectatic right brachiocephalic trunk. The case was further evaluated with virtual bronchoscopy and three-dimensional vascular reconstruction. The final diagnosis was bilateral bronchopneumonia with concomitant IACS. This case is notable for its rarity in the elderly population and highlights a novel association between prior anterior cervical spine surgery, resultant thoracic skeletal remodeling, and acquired IACS. We discuss the pathophysiology, diagnostic approach, and implications for clinical management.