A 73-year-old female presented as an outpatient from her primary care physician for a CT of the thorax, abdomen, and pelvis to evaluate a reportedly stable abdominal aortic aneurysm. Pertinent past medical history revealed a left supraclinoid internal carotid artery aneurysm, a stable infrarenal abdominal aortic aneurysm, systemic lupus erythematous/rheumatoid arthritis overlap syndrome, smoldering IgG lambda myeloma, chronic kidney disease (stage II), hyperparathyroidism, and a cerebral infarction in the right posterior cerebral artery territory in 2009. Findings on the CT of the thorax demonstrated a fusiform superior vena cava (SVC) aneurysm measuring 5.9 × 4.4 × 6.1 cm (anterior-posterior × transverse × craniocaudal). No thrombus was noted within the SVC aneurysm (). The aneurysm was first partially visualized in 2007 on a cervical spine CT, and since that time it had remained stable on annual follow-up CTs.\nThe patient's course between 2007 and the most recent study in 2016 included an extensive rheumatologic and hematologic workup, including a temporal artery biopsy in 2015. Pathology revealed intimal hyperplasia with focal internal membrane disruption, but no features of granulomatous vasculitis were identified.\nThe etiology of the SVC aneurysm in this patient is uncertain. Potential causes in this patient include autoimmune disease (RA/SLE), which seems unlikely. Pathology did not reveal any convincing evidence of vasculitis. The arterial aneurysms are also felt to be unrelated as the patient has significant atherosclerotic disease. While an iatrogenic cause is possible, a chart review did not elicit any complications relating to prior hemodialysis catheter placement. Therefore, we surmised that the SVC aneurysm was likely idiopathic.\nThis patient did not receive any anticoagulation to prevent thrombus formation within the SVC aneurysm, and no repair was ever attempted. For the six years during which the patient was under observation at our institution, an SVC thrombus or sequela of an embolus originating from the SVC has never been observed. While the patient had a cerebral infarct in 2009, there was no evidence of right to left circulatory shunt. The observatory management of the SVC aneurysm in this patient stands in contrast with the majority of the cases found in the literature. Most patients were treated prophylactically for theoretical complication.
A 30-year-old, asymptomatic female presented to our hospital for a physical examination. The patient had a history of diabetes mellitus and no history of cigarette smoking, hepatitis, tuberculosis, hypertensive disease, or coronary disease. Written informed consent was obtained from the patient for the publication of the present study. Enhanced CT (Philips, Brilliance ICT CP 200063) of the chest revealed an anterior mediastinal oval tumor 2.3 × 1.7 × 1.3 cm in size with border regularity and without necrosis and calcification (Fig. ). A preoperative diagnosis of thymoma was considered due to the enhanced CT features. Routine blood, coagulation function, liver function, serum electrolyte, and electrocardiogram results were all within normal limits (Table ). For the purpose of providing a definitive diagnosis and treatment for an anterior mediastinal tumor such as thymoma, video-assisted thoracoscopic surgery (VATS) was performed under general anesthesia. Histopathological examinations using hematoxylin and eosin staining (Sinopharm Chemical Reagent Co., Ltd., Shanghai, China) revealed that the tumor exhibited the typical histological findings of a cavernous hemangioma, as it was comprised of a proliferation of sized vessels (Fig. ). The patient presented with chylothorax on the second postoperative day and was discharged on the 13th postoperative day. One-year post surgery, the patient was alive with no evidence of tumor recurrence.