Images in vascular medicine. 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 Images in Vascular Medicine