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 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.