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 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.