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 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.