Resection of an azygos vein aneurysm with thrombosis

Aneurysm of the azygos vein is rare. We describe the case of a 51-year-old nonsmoking woman with a posterior mediastinal mass caused by a giant azygos vein aneurysm with subtotal thrombosis. Surgical resection of the azygos vein was offered to our patient as a treatment option owing to theoretical risks of rupture and pulmonary embolism. After taping the azygos vein proximally and distally, the aneurysm was resected with video-assisted thoracoscopy. Approximately 30 cases have been reported in the literature to date. Dynamic computed tomography and a videoassisted approach were useful for the diagnosis and treatment for this abnormality.     

Azygos Vein Aneurysm - A Case for Elective Resection by Video-assisted Thoracic Surgery

An azygos vein aneurysm is a very rare cause of a posterior mediastinal mass. Once the diagnosis has been confirmed, no treatment is usually required. However, the aneurysm can thrombose, and this may lead pulmonary thromboembolism, or the aneurysm may rupture. In these instances, the excision of the mass is recommended. Video-assisted thoracic surgery techniques have considerably improved. If it is necessary to remove the aneurysm, video-assisted thoracic surgery may be a good option for surgical treatment. We report a case of an aneurysm of the azygos arch that was successfully resected by video-assisted thoracic surgery.     

Resection of an azygos vein aneurysm that formed a thrombus during a 6-year follow-up period

We report a resection of an azygos vein aneurysm that formed a thrombus during a 6-year follow-up period. An azygos vein aneurysm is commonly detected as an asymptomatic mediastinal mass. A thrombus could suddenly form without enlarging the aneurysm. Therefore we suggest that even asymptomatic azygos vein aneurysms causing blood stagnation should be resected before they can form a thrombus and cause a pulmonary embolism.     

Spontaneous splenic vein aneurysm rupture in the puerperium

A case of intra- and retroperitoneal haemorrhage after a splenic vein aneurysm rupture is described. A 27-year-old woman complained of chest pain on her first postpartum day. Symptoms were initially suggestive of pulmonary embolism, but within 3 h she developed severe acute abdominal pain, abdominal distension and haemodynamic instability. Ultrasound demonstrated a non-echogenic mass in the abdomen suggestive of a fluid collection and a computed tomography scan confirmed the presence of a lesion at the pancreatic tail. Urgent laparotomy revealed splenic vein rupture near the pancreatic tail. Partial pancreatectomy and splenectomy were performed. The patient subsequently made an uneventful recovery. Histological examination revealed a splenic vein aneurysm and chronic inflammatory changes in the pancreatic tissue. Rupture of a splenic vein aneurysm is a rare event and the diagnosis may present difficulty because its presentation is similar to several other more common conditions. However, rupture of a splenic vein aneurysm should be suspected in any pregnant woman with unexplained abdominal pain or with clear signs of haemorrhage, as delay in diagnosis can have devastating consequences.     

Large aneurysm of innominate vein: extremely rare cause of mediastinal mass

Aneurysms of the innominate vein are extremely rare. Fifteen such cases have been reported in literature. They may be asymptomatic or may present as a mediastinal mass with compression of adjacent structures or may present with vascular complications like thromboembolism or rupture. We present a case of large innominate vein aneurysm presenting as a mediastinal mass that was surgically excised through a left thoracotomy without use of cardiopulmonary bypass.     

Venous aneurysm of V. saphena accessoria--a case report

A 43-year-old male was admitted for subcutaneous mass of rt. inguinal lesion. Saccular dilatation of vein is a rare phenomenon and usually termed "venous aneurysm". Venous aneurysm has been reported in the following vein: face, neck, extremities, superior vena cava region, portal vein region and by-pass grafting vein. This is the 1st report of a venous aneurysm found in V. saphena accessories in Japan. The true etiology is unknown, but underlying causes which produce damage to the venous wall (trauma, inflammation, congenital weakness, and localized degenerative change) have been mentioned as possible causes. Rarely, thrombosed venous aneurysm may cause pulmonary emboli. Definitive diagnosis is established by venography. Venous aneurysm often increases or reduces in size according to the change of venous pressure by proximal vein compression postural change and Valsalva maneuver. In general, surgical resection of the aneurysm is the treatment of choice.     

Traumatic venous aneurysm. Case report

A traumatic venous aneurysm within the greater saphenous vein occurred in a 15-year-old hockey player. The patient had early diagnosis and surgical excision of the lesion. Venous aneurysm is a rare clinical entity and a pathologic curiosity in the absence of varicose veins. It can lead to serious complications, such as pulmonary embolism, portal hypertension, and rupture. Early diagnosis with the use of venography and surgical excision of the lesion can prevent major complications.     

Saphenous vein graft aneurysm: potential for mistaken identity

We report the unusual presentation of a saphenous vein graft aneurysm in a 72-year-old man who had undergone coronary artery bypass surgery 15 years prior to admission. The patient presented with a large mass on the anterior wall of the right ventricle and chest discomfort; initially believed to be a cardiac tumor. The patient underwent reoperative coronary surgery with excision of the saphenous vein graft aneurysm, followed by an uneventful postoperative course. Aortocoronary saphenous vein graft aneurysms are rare and their presentation may be mistaken for pulmonary or chest wall lesions. Complications include rupture, and therefore require attentive diagnosis and surgical therapy.     

Idiopathic azygos vein aneurysm: a rare cause of mediastinal mass

Venous aneurysm of the azygos arch is a very rare cause of mediastinal mass and is usually an incidental finding on chest radiography. Nowadays the diagnosis is made by non-invasive tests such as thoracic CT scanning and/or magnetic resonance imaging. The case is described of an asymptomatic woman in whom a mediastinal mass due to an azygos vein aneurysm was diagnosed by non-invasive procedures, the aetiology of which, in all probability, was idiopathic.     

Saphenous Vein Graft Aneurysm: Potential for Mistaken Identity

Abstract We report the unusual presentation of a saphenous vein graft aneurysm in a 72‐year‐old man who had undergone coronary artery bypass surgery 15 years prior to admission. The patient presented with a large mass on the anterior wall of the right ventricle and chest discomfort; initially believed to be a cardiac tumor. The patient underwent reoperative coronary surgery with excision of the saphenous vein graft aneurysm, followed by an uneventful postoperative course. Aortocoronary saphenous vein graft aneurysms are rare and their presentation may be mistaken for pulmonary or chest wall lesions. Complications include rupture, and therefore require attentive diagnosis and surgical therapy.     

Aneurysm of an aortocoronary saphenous vein bypass graft presenting as an anterior mediastinal mass

Fifteen years after aortocoronary bypass surgery, a 52-year-old asymptomatic man was found to have a large anterior mediastinal mass. Angiographic studies showed no evidence that a vascular structure was responsible. At operation, a saphenous vein graft to the left anterior descending artery was found to be affected by a large thrombus-filled aneurysm. This is one of the few known cases in which such an aneurysm has presented as a mediastinal mass.     

Idiopathic saccular aneurysm of the azygos vein

Idiopathic saccular aneurysm of the azygos vein is a rare condition. We report the case of a 52-year-old man with saccular aneurysm of the azygos vein who underwent surgical resection. Preoperative dynamic computed tomography revealed strong and rapid enhancement of the chest mass. Magnetic resonance imaging showed a thoracic tumor with low signal intensity on the T1-weighted image and coexistence of low and high signal intensity on the T2-weighted image. Intraoperative findings showed cystic dilatation of the azygos vein. Although an accurate preoperative diagnosis of saccular azygos vein aneurysm is difficult, especially differential diagnosis between this anomaly and mediastinal tumors, a markedly enhanced mass shown by dynamic computed tomography was useful for the preoperative diagnosis of this anomaly.     

Radical surgery of a giant Galen's vein aneurysm using total circulatory arrest: case report

BACKGROUND: Arteriovenous malformations of Galen's vein are a rare type of vascular anomaly. The complex anatomy of these lesions creates an extremely difficult management dilemma. We report successful surgical treatment of a 7-year-old patient with a Galen's vein aneurysm. METHODS AND RESULTS: A 7-year-old patient with slowly progressing gait disturbance, emotional instability, and strange behaviour is presented. A computed tomography scan revealed a high-density mass in the pineal region and cerebral angiography showed an aneurysm of Galen's vein. We decided to perform surgical excision of the aneurysm. The operation was performed under hypothermic circulatory arrest with barbiturate cerebral protection. The patient had no signs of postoperative ischemic deficits, hemorrhage, or neurologic deterioration. CONCLUSIONS: Various techniques have been described for the obliteration of Galen's vein aneurysms, including direct surgical approach, staged operation, and transarterial, transvenous or transtorcular embolization. We present this patient to illustrate the use of hypothermic circulatory arrest and barbiturate cerebral protection for successful surgical excision of this complex vascular lesion. The combination of these techniques allowed us, in this case, to operate with reasonable safety on otherwise, difficult to treat aneurysm of Galen's vein.     

Solitary aneurysm of the middle lobe artery. A case report and review of solitary peripheral pulmonary artery aneurysms

A patient with a solitary peripheral pulmonary artery aneurysm successfully treated by operation is presented. This is the oldest patient in whom an aneurysm of this type has been removed by lobectomy, and the aneurysm is the first recorded in the right middle lobe.The literature on this entity is reviewed, and the diagnosis and etiology are discussed. Of 35 patients having a solitary peripheral pulmonary artery aneurysm, 21 died from rupture, an outcome which strongly supports the role of operation for this problem.The solitary peripheral pulmonary artery aneurysm is yet another entity to be considered in the differential diagnosis of the so-called coin lesion. Pulmonary angiography may be necessary to exclude multiple aneurysms.     

Azygos vein aneurysm as a diagnostic pitfall

We report the case of an azygos vein aneurysm that was found intraoperatively in a 66-year-old woman followed for esophageal carcinoma. She underwent video-assisted thoracoscopy surgery (VATS) for biopsy of a mediastinal mass. This mass was diagnosed in the 2nd year of postoperative follow-up for a T2N0M0 esophageal carcinoma by computed tomography, which revealed a heterogeneous mass of ~2 cm in diameter in a retrotracheal location. Preoperative echoendoscopy demonstrated an extraesophageal lesion. A diagnostic thoracoscopy was done in order to exclude a metastatic lymph node disease.     

Mycotic aortocoronary saphenous vein graft aneurysm presenting with unstable angina pectoris

We report the case of a 60-year-old man with a history of coronary bypass surgery 20 years prior who had a fever, chest pain, and a mediastinal mass develop after a complicated postoperative course of abdominal aortic aneurysm resection. A mycotic aneurysm of the saphenous vein graft to his left anterior descending coronary artery was diagnosed based on blood culture results and visualization of the aneurysm before resection. A summary of the saphenous vein graft aneurysm and pseudoaneurysm cause, diagnosis, and management is detailed.     

A pediatric patient with a mediastinal mass and pulmonary embolus

When anesthetizing a patient with an anterior mediastinal mass, sudden hypoxaemia and cardiovascular collapse may result from compression of a large airway or vascular structure in the mediastinum. We report the case of a pediatric cancer patient with an anterior mediastinal mass, who developed sudden and fatal hypoxaemia and cardiovascular collapse in the hours following sedation. A massive pulmonary thromboembolism was diagnosed at autopsy. We suggest that pulmonary embolism should be considered in the differential diagnosis when a patient with a mediastinal mass develops perioperative hypoxaemia, cardiovascular collapse, or both.     

Giant aneurysm of aortocoronary saphenous vein graft compressing the left pulmonary artery

This is a case report of a 78-year-old patient with a 7-cm aneurysm of the saphenous vein graft that was used 17 years before to perform a coronary artery bypass grafting on the circumflex artery. CT scan displayed a mass with an internal lumen compressing the left atrium as well as the left pulmonary artery.     

Innominate venous aneurysm presenting as a rapidly expanding mediastinal mass

Thoracic venous aneurysms are extremely rare conditions. Only 14 innominate venous aneurysms have been reported in the literature. We report a case of a 13-year-old girl who presented with a mediastinal mass on chest roentgenogram, which was performed because the patient was postoperatively tachypneic after a routine appendectomy. Further investigations revealed a large left innominate venous aneurysm that was growing rapidly. The patient underwent aneurysmectomy and reconstruction of the innominate vein. The patient's postoperative course was uneventful, and her respiratory symptoms resolved.     

Tuberculous esophagitis with aortic aneurysm fistula

A patient with treated pulmonary tuberculosis and a thoracic aortic aneurysm was seen with a one-month history of dysphagia. Barium swallow revealed a mass in the lower esophagus and extravasation of contrast material into the mediastinum. Endoscopy and biopsy specimens showed acid-fast organisms. The patient was treated with antituberculous drug therapy but bled massively from the gastrointestinal tract and died. Autopsy revealed an aortoesophageal fistula at the level of the thoracic aneurysm. Histopathological study confirmed that this rare tuberculous lesion of the esophagus caused the fistula.