A superior vena cava (SVC) aneurysm is an extremely rare case of vascular malformation in the chest cavity. This is a report of a case of a 57-year-old woman with a saccular SVC aneurysm which was 8 cm wide. The chest computed tomography (CT) scan confirmed a giant 75 mm × 79 mm × 81 mm mass containing the contrast medium from SVC, constricting the right lung parenchyma, narrowing the right innominate vein, in contact with the anterolateral chest cavity wall, and adjoining the superior mediastinum.Under general anesthesia and employing the median sternotomy approach, using a cardiopulmonary bypass (CPB), the venous aneurysm was successfully resected. The postoperative period was uneventful. Radical surgical resection using a sternotomy and a CPB is recommended. and was entirely constricting the right upper lobe of the lung. After the mass was dissected from the right phrenic nerve and the surrounding tissue, we used a vascular clamp to exclude the neck of the aneurism. The mass was detached; the neck of the aneurysm was continuously sutured and strengthened with teflon felt patches (Figure 2).A histopathological examination was conducted and this confirmed that the mass which had been removed was a part of a venous blood vessel. A control CT scan and chest X-ray was done after surgery ( Figure 3). Because of an uneventful postoperative period, the patient was discharged on the 5th day after the procedure.
DiscussionA vein aneurysm is an extremely rare phenomenon in medicine. In 1963, Abbot and Leight introduced a classification of aneurysms and divided them into four groups (congenital, acquired, pseudo-aneurysm, and arteriovenous aneurysm) (2). The fusiform aneurysm constitutes the vast majority. In our case we are presenting a saccular aneurysm, which has only been described in literature a few times. Such aneurysms are usually asymptomatic and are usually diagnosed accidentally in routine chest X-rays. Detailed diagnostics include a CT scan or magnetic resonance imaging (MRI). Aneurysms might be congenital, or caused by inflammation or by the degeneration of the vascular wall, but in most cases their cause is unknown (3). They might be solitary or they may coexist with cystic hygromas and angiomas. In asymptomatic patients where the diameter of the aneurysm is less than 40 mm, we might proceed conservatively, using anti-plaque therapy and periodic scans (4). Aneurysms which are larger, growing, symptomatic or containing thrombus require radical surgical treatment (3,5,6). Part of the thrombus forming the sack of the aneurysm can break away and cause pulmonary embolism or lung infarct which may lead to the patient's death (7,8). Particular caution is required in this circumstances. Thanks to CPB, our patient was protected from pulmonary embolism and lung infarct. The use of CPB should be considered not only when the thrombus formation is detected, but also in the case of calcification in the wall of the aneurysm (5). In our opinion, the type of surgical approach presented here gives better insight ...