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A 24-year-old female with venous aneurysm of the persistent left superior vena cava and the left subclavicular vein has been reported. Spontaneous closed rupture of the venous aneurysm, secondary to thrombosed obstruction, occurred into the posterior mediastinum and the extrapleural thoracic wall. The symptom was aggravated rapidly because of absent communicating vein between the persistent left superior and the right superior venae cavae. Surgical intervention was not considered for the reason of difficulty in approach. Fortunately an open rupture of the venous aneurysm into the thoracic cavity was not seen. A conservative treatment for 4 months resulted in a successful outcome with absorption of a large hematoma and building of collateral circulation.

Twenty-two cholangiograms of adults with congenital dilatation of the common bile duct were studied and analyzed. Diagnosis of this disease was established by endoscopic retrograde cholangiopancreaticography in nine patients, by percutaneous transhepatic cholangiography in two patients, and by operative cholangiography in 11 patients. All patients, except one with Caroli's disease, were classified as type I according to Alonso-Lej. An anomalous junction of the pancreaticobiliary ductal system (AJPBDS) was observed in 15 cases. In nine patients the common bile duct joined the main pancreatic duct, and in the remaining six patients, the pancreatic duct was noted to join the common bile duct. These anomalies are considered to be an important etiologic factor in the development of choledochal dilatation. Total cyst excision and hepaticojejunostomy in a Roux-en-Y fashion is recommended as the procedure of choice in those cases with AJPBDS. This is based on the high incidence of cholangitis and the high propensity to induce malignancy of cystic wall following simple drainage.

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