A 52-year-old man was admitted to our hospital for mediastinal mass found incidentally in health examination. He had no special disease history or any symptoms. No face or upper extremity edema was found in physical examination. Enhanced chest computer tomography (CT) showed a size of 5.6*4.3 cm mass in anterior mediastinum, which was enhanced in the artery phase (Fig. ), and it had no clear boundary with left innominate vein and SVC. The CT report suggested high possibility of thymoma. Echocardiographic examination did not reveal any abnormality. Thymoma was diagnosed and he received operation in our hospital through median sternotomy on July 2019. During the operation, a dark red and saccular mass was found in anterior mediastinum with slight pulsation. The mass had no clear boundary with left innominate vein and further exploration revealed they were connected with each other. The membrane of the mass seemed to be very thin and easily bled when touched. Left innominate venous aneurysm with part of SVC involved was highly suspected.\nThe venous aneurysm was resected with the proximal and distal end of the left innominate vein blocked (Fig. ). However, the majority of the left innominate vein wall was involved and only a little part of vessel wall was left after the venous aneurysm was resected, which made the reconstruction of the left innominate vein necessary. Because of the misdiagnosis and lack of abundant preoperative preparation, we decided to take pericardium as material for repairment and reconstruction. We first resected the involved part of SVC with it blocked, and repaired it with a small piece of pericardium. The SVC was unblocked immediately after repairment was finished. Then we took a large piece of pericardium and wrapped it around a needle tube, suturing the two sides to make it a tube in shape with the smooth surface inside (Fig. ). The tube was first anastomosed to the distal end of the left innominate vein. Then we blocked the SVC again and opened a small hole in the side wall and anastomosed the other side of the tube with SVC. The reconstructed left innominate vein and SVC seemed patent and firm (Fig. ). Low molecular heparin was used once per day just for routine anticoagulation after surgery. The patient had an uneventful postoperative course and was discharged 6 days after surgery. He did not take anticoagulant drugs after discharge and was satisfied with the treatment therapy. The pathological diagnosis was mediastinal hemangioma. The patient kept in good condition on the last follow up date of December 2019.
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.