A 52-year-old man was referred to our hospital for assessment of a suspicious mass that was detected on a chest radiography during a routine health check. He denied symptoms, including chest pain, hoarseness, hemoptysis, cough, dry cough, and dyspnea. He was a nonsmoker and had no exposure to any environmental fumes or dust.\nPhysical examination revealed normal breathing sounds in both lung fields. Laboratory findings were within normal limits. In these examinations, hematology test results and biochemistry test results were within regular levels. Plain chest computed tomography (CT) displayed a circumscribed soft tissue mass that was located in the anterior mediastinum, measuring 2.1 × 1.4 cm (Figure A). Contrast-enhanced CT showed a demarcated soft tissue mass with no calcification and marginal enhancement (Figure B). The lesion was suspected to be a thymoma rather than a vascular neoplasm before surgery.\nAs a diagnosis was not established through imaging, surgery was scheduled. We approached the tumor, which was removed by thymectomy using video-assisted thoracic surgery (VATS) rather than a median sternotomy. The thymectomy was performed in the lateral decubitus position, utilizing a three-port, right-sided VATS approach under general anesthesia administered through a double-lumen endotracheal tube. Three entry ports were made at the third and sixth intercostal spaces of the right posterior axillary, midaxillary, and midclavicular lines. The camera was introduced via trocar through the lower port at the sixth intercostal space of the midaxillary line. The operative procedure involved removal of the entire thymus gland including the anterior mediastinal fat, with careful attention to preservation of the phrenic nerve and control of thymic venous tributaries draining into the left brachiocephalic vein. There was no invasion into adjacent structures. After careful attention to hemostasis, a chest tube was placed to drain the pleural cavity, and the right lung was reinflated under direct vision. Macroscopically, examination of the resected specimen showed an encapsulated tumor measuring 2.2 × 1.2 × 0.8 cm in the thymus that could be palpated as a soft nodule. The cut surface seemed to have some fresh blood and the soft tissue was taupe, and no phlebolith was discerned in the center. Histopathologically, it was diagnosed as a cavernous hemangioma consisting essentially of a large number of dilated vessels with a single layer of endothelial cells with no signs of atypia or mitosis. Most of the channels contained red blood cells in the cavity (Figure ). No tumor tissue was detected at the surgical margin.\nThe postoperative course was ordinary. The patient was discharged 3 days after the operation with no complication. He has been followed up for 8 months without evidence of recurrence.
A 42-year-old female was referred to the outpatient department, with features suggestive of lower respiratory tract infection. Physical examination was unremarkable. She had no history of any cardiac disease or injury to thoracic cage. She had no history of antecedent serious illness. Family history was also non-contributory.\nChest X-ray was done for the workup of respiratory symptoms, which showed abnormal contour and widening of right border of mediastinum (). In chest X-ray, the cervico-thoracic sign and hilum overlay sign were present in posteroanterior (PA) view. Lateral view showed anterior bulging of mediastinum.\nComputed tomography (CT) of thorax was done for further workup in angiographic protocol which was suggestive of aneurysmal ectasia of SVC and patchy consolidation of right lower lobe. Aneurysmal ectasia of SVC measuring 4.5 × 5.5 cm in maximum dilatation and for a length of 8.9 cm without internal thrombosis or dissecting flap was present ( and ). No other vascular anomalies were detected.\nSince CT did not reveal any signs of obstruction, we believe that the SVC aneurysm is primary and can be classified as congenital primary superior vena caval aneurysm (CPSVCA), class 1A as per Abott’s classification (1964) [].