A 24-year-old male came to the thoracic surgery clinic with an acute onset of dyspnea, stridor, a worsening cough, and chest pain that had been worsening over several months. A chest x-ray showed a mediastinal mass and comminuted fracture of the sternoclavicular joint (), and a subsequent computed tomography angiography with reconstruction revealed 5.3 cm of non-ruptured pseudo-aneurysm near the root innominate artery. () and severe compresion in the trachea (). Thoracic surgery clinics refer patients to cardiovascular surgery clinics. His medical history was significant for blunt chest trauma secondary to a bicycle fall 3 months earlier. To alleviate compressive symptoms of the trachea and the absence of endovascular repair in our country, the patient was admitted to the ER and underwent open repair of his brachiocephalic pseudoaneurysm. Surgical approach through the median sternotomy: after opening the sternum, an aneurysm sac ruptured and started bleeding controlled by digital pressure to avoid blind clamp occlusion. Fortunately, we controlled side clamps in the proximal brachiocephic artery, distal right sublavian, and common carotid arteries. The injury site () was repaired with primary repair by using 5/0 prolen. One drain was inserted in the mediastinum, a normal post-op chest x-ray (). There were no complications from the surgery. The patient was discharged on the seventh day. Almost a year after the injury, the patient is doing well and has a normal chest x-ray ().