A 52-year-old male patient was admitted to the hospital due to an irritating cough for more than 1 month. He had no recent history of chest trauma surgery or respiratory diseases. A chest CT scan showed anterior mediastinal space, and showed differential diagnosis of teratoma, thymoma and lymphomas, in order to clarify the relationship between the space-occupying lesions and blood vessels and surrounding tissues, a chest-enhanced CT examination was performed. After intravenous injection of contrast medium, a dual-phase scan was performed. It was found that there was a localized aneurysm-like expansion in the left brachiocephalic vein and its diameter was 5.2 cm with the smooth edge (Fig. ), which confirmed the diagnosis of venous aneurysm. After careful evaluation of the patient, surgery was performed.\nA median sternum incision was selected in the surgery. During the operation, a huge aneurysm is found to be located in front of the left brachiocephalic vein. The aneurysm and surrounding tissues were carefully separated to prevent uncontrollable bleeding during the process, and to mechanical damage caused by extracorporeal circulation. We first performed heparinization of the whole body blood, and blocked both ends of the brachiocephalic vein, separated the fibrous membrane of the venous blood vessel, and found that the aneurysm wall was thin. The aneurysm was cystic expansion, and there as a larger aneurysm neck connected to it. After the aneurysm was removed, a double-layer continuous suture with 5–0 prolene thread was used to suture the brachiocephalic vein. We paid attention to the shape of the normal brachiocephalic vein during the suture process. To prevent vascular distortion and lumen stenosis, we carefully loosened the blocking bands at both ends before knotting, determined the shape of the formed blood vessel, and expelled the possible air (Fig. ). After confirming that there is no obvious active bleeding, heparin was neutralized with protamine, and the operation ended after the sternum is fixed by the wire.\nThe mediastinal drainage tube was removed on the third day after the operation, and the patient was discharged from the hospital 2 days later. Postoperative pathology showed that the specimen was thinned venous wall tissue (Fig. ). He was followed up for 6 months, and there was no obvious abnormality in the chest enhanced CT, with good recovery.
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) [].