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) [].
A 50-year-old female patient presented with the incidental finding of an anterior mediastinal mass on chest radiography during a routine health examination in October 2020. No related subjective symptoms were reported and the physical examination showed no abnormalities. Contrast-enhanced computerized tomography (CT) of the chest showed a 4.8 × 4.6 cm anterior mediastinal mass with significant homogenous enhancement after injection of the contrast (mean CT values before and after contrast injection were 38 and 115 HU, respectively), suggesting a diagnosis of Castleman's disease, but not excluding thymoma ().\nThe patient underwent surgical resection of the anterior mediastinal mass under a thoracoscopic approach. After the intubation of the single lumen tube with a bronchial obstruction balloon, single lung ventilation on the contralateral side was performed under general anesthesia. The patient was placed in the lateral position with a retroversion of 30°. The operation was performed via a single-utility port: the endoscopic port was a 1-cm incision at the 6th intercostal space in the midclavicular line, and the utility port was a 3-cm incision at the 4th intercostal space along the anterior axillary line. Intraoperatively, the anterior mediastinal mass was determined to be an aneurysm originating from the left innominate vein. Through careful surgical manipulations and adequate exposure of the operative field, the root of the aneurysm was fully dissected and ligated, and then the root vessel was divided with a cutter closure (). Postoperative pathology confirmed the diagnosis of left innominate vein aneurysm. The patient experienced an uneventful postoperative course. The thoracic drainage tube was removed on postoperative day 1 after chest X-ray imaging showed complete re-expansion of the lung, with no obvious pneumothorax or hydrothorax. She was discharged from the hospital on postoperative day 2. At her 6-month follow-up, the patient did not report any specific discomfort.