Twenty-eight years later: A case of superior vena cava aneurysm secondary to cystic hygroma

Abstract

A 34-year-old obese female with a history of left neck cystic hygroma (post-resection and facial reconstruction at age 6 years) was referred for evaluation of asymmetric mediastinal widening on chest X-ray obtained during bariatric surgery evaluation (Panel A, arrows). No prior chest imaging was available. Subsequent chest computed tomography (CT) showed a fusiform aneurysm of the superior vena cava (SVC) (5.3 × 3.4 cm on double oblique measurement; Panel B) and innominate vein, with adjacent curvilinear vascular structures within the surrounding fat, consistent with lymphatic or venolymphatic malformations. The patient was completely asymptomatic, without evidence of SVC obstruction on physical examination. Vascular surgery was consulted and recommended imaging surveillance without initiation of therapeutic anticoagulation, as the aneurysm was felt to likely be congenital and would not warrant intervention if it remained stable on serial evaluations.SVC aneurysms are very rare, usually asymptomatic, and are typically incidentally diagnosed during chest radiography. 1 The majority of these aneurysms are fusiform as opposed to saccular. In a previous case series of 15 patients

A Rare Case of Superior Vena Cava Saccular Aneurysm

“…Prophylactic surgical resection to prevent aneurysmal rupture is recommended for saccular aneurysms that are >40 mm, growing, symptomatic, or contain thrombus. 1,4,9 The classification of our patient's thoracic lesion was believed to likely represent a venolymphatic malformation, on the basis of the International Society for the Study of Vascular Anomalies classification system. Truncal venolymphatic malformations are thought to arise sporadically in most cases, but rare familial inheritance patterns do exist.…”