Abstract
Superior vena cava aneurysm is a rare life-threatening intrathoracic vascular lesion. Contrast-enhanced CT examination plays an important role for surgical planning. It needs to choose the appropriate vein as the puncture site for contrast agent injection. Hereby we report a 22-year-old male presented with sudden-onset dyspnea and unconsciousness for 2 hours and suffered from cardiac arrest before visiting our hospital. The patient's condition is critically ill, and the risk of contrast agent extravasation and aneurysm explosion is high. We established a multi-disciplinary team, involving Emergency Department, Cardiac Surgery Department, Radiological Department and intravenous therapy experts, for the integrated assessment of patients. And we activate the emergency cooperation protocol for critically ill patients. The superior vena cava can’t be used for contrast injection. Anatomically, the femoral vein drains blood back to the heart through the inferior vena cava, which could avoid the risk of rupture of the superior vena cava aneurysm due to excessive pressure of bolus injection of contrast agent. The indwelling of femoral vein puncture can be used in the treatment of critically ill patients. The vital signs of patients were closely observed during the examination process. No contrast agent extravasation and allergy reaction was observed and CT images were clear. The effective nursing cooperation in this case ensured the safety and effectiveness of the examination, and laid the foundation for further treatment.
Highlights
Superior vena cava aneurysm, whose symptoms include chest pain, cough, expectoration, and shortness of breath on exertion, is a rare intrathoracic vascular lesion [1]
A critically ill patient is considered to be with a huge superior vena cava aneurysm
Contrast-enhanced CT examination plays an important role for surgical planning
Summary
Superior vena cava aneurysm, whose symptoms include chest pain, cough, expectoration, and shortness of breath on exertion, is a rare intrathoracic vascular lesion [1]. Since its symptoms and signs aren’t obvious and non-specific, and its etiology is still unknown, superior vena cava aneurysm tends to be misdiagnosed in early stage [3] It has a great impact on patients’ health due to its serious complications, such as rupture, thrombosis, and pulmonary embolism [4]. Internal jugular vein or subclavian vein catheterization is the common chosen route for contrast medium injection [7]. Both these two veins drained through the superior vena cava back to the right atrium. After multi-disciplinary cooperation and careful nursing cooperation, the femoral vein was chosen as the route for contrast injection, which had not been reported in previous literatures, so that the patient could undergo contrasted-enhanced CT examination effectively and successfully.
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