A 26-year-old patient, on the 10th day of the puerperium, presented sudden pain in the left cervical region irradiated to the supraclavicular region on the same side, followed by the presence of a pulsatile mass. She reported a mean systolic hypertension of 160 mmHg, and mean diastolic hypertension of 130 mmHg in pregnancy and neurofibromatosis. At physical examination, she presented a pulsatile mass in the left supraclavicular region, without thrill and/or murmur. A widening of the mediastinum was detected by a thoracic X-ray. A computed tomography (cervical and thoracic region) showed a pulsatile mass in the territory of the left subclavian artery in its proximal portion, without having limits defined by contrast extravasation, besides a giant hemothorax on the left. The patient evolved with hypovolemic shock and was submitted to an urgent surgery, undergoing thoracotomy followed by cervicotomy, in which a ruptured aneurysmal lesion of the left vertebral artery was shown right after its emergency. After controlling the bleeding, a ligation was performed. The patient progressed satisfactorily, having an outpatient follow-up. Copyright © 2005 by Sociedade Brasileira de Angiologia e Cirurgia Vascular.43297300Riccardi, V.M., Von Recklinghausen neurofibromatosis (1981) N Eng J Med, 305, pp. 1617-1627Sasaki, J., Miura, S., Ohishi, H., Kikuchi, K., Neurofibromatosis associated with multiple intracranial vascular lesions: Stenosis of the internal carotid artery and peripheral aneurysms of the Heubner's artery: report case (1995) No Shinkei Geka, 23, pp. 813-817Zhao, J.Z., Han, X.D., Cerebral aneurysm associated with von Recklinghausen's neurofibromatosis: A case report (1998) Surg Neurol, 50, pp. 592-596Watano, K., Okamoto, H., Takagi, C., Matsuo, H., Hirao, N., Kitabatake, A., Neurofibromatosis complicated with XXX syndrome and renovascular hypertension (1996) J Intern Med, 239, pp. 531-535Muhonen, M.G., Godersky, J.C., Vangilde, J.C., Cerebral aneurysms associated with neurofibromatosis (1991) Surg Neurol, 36, pp. 470-475Nakhoul, F., Green, J., Ofer, A., Ben-izhak, O., Lewin, M., Renovascular hypertension associated with neurofibromatosis: Two cases and review of the literature (2001) Clin Nephrol, 55, pp. 322-326Serleth, H.J., Cogbill, T.H., Gundersen, S.B., Rupture pancreaticoduodenal artery aneurysms and pheochromocytoma in a pregnant patient with neurofibromatosis (1998) Surgery, 124, pp. 100-102Niimi, M., Ikeda, Y., Kan, S., Takami, H., Furui, S., Takeshita, K., Spontaneous rupture of intercostals artery due to neurofibromatosis type 1 disease treated by percutaneous embolization (2002) Cardiovasc Intervent Radiol, 25, pp. 160-161Kirchhof, K., Vogt-schaden, M., Forsting, M., Fusiform aneurysm of the basilar artery in Recklinghausen's disease (1996) Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr, 165, pp. 412-414Tins, B., Graves, M., Bowling, T., Neurofibromatosis associated with coronary artery aneurysm (2000) Br J Radiol, 73, pp. 1219-1220Fabris, V.E., Tumores vasculares (2002) Doenças Vasculares Periféricas. 3 a Ed., pp. 1798-1799. , Lastória S, Maffei FHA, Yoshida WB, Rollo HA. Rio de Janeiro: MedsiFaro, S.H., Mahboubi, S., Ortega, W., CT diagnosis of rib anomalies, tumors, and infection in children (1993) Clin Imaging, 17, pp. 1-7Villavicencio, A.T., Gray, G., Leveque, J.C., Fukushima, T., Kureshi, S., Friedman, A.H., Utility of three-dimensional computed tomographic angiography for assessment of relationships between the vertebrobasilar system and cranial base (2001) Neurosurgery, 48, pp. 318-327Johnson, C.E., Russel, E.J., Huckman, M.S., Resolution of spinal epidural vascular pseudotumor following balloon occlusion of a postoperative vertebral arteriovenous fistula (1990) Neuroradiology, 31, pp. 529-532Matsushima, T., Matsukado, K., Natori, Y., Inamura, T., Hitotsumatsu, T., Fukui, M., Surgery on a sacular vertebral artery-posterior inferior cerebellar artery aneurysm via the transcondylar fossa (supracondylar transjugular tubercle) approach or the trancondylar approach: Surgical results and indications for using two different lateral skull base approaches (2001) J Neurosurg, 95, pp. 268-274Day, J.D., Fukushima, T., Giannotta, S.T., Cranial base approaches to posterior circulation aneurysms (1997) J Neurosurg, 87, pp. 544-554Inamasu, J., Suga, S., Sato, S., Onozuka, S., Kawase, T., Long-term outcome of 17 cases of large-giant posterior fossa aneurysm (2000) Clin Neurol Neurosurg, 102, pp. 65-71