A case report of surgical repair of large superior vena cava saccular aneurysm with thrombosis

Superior vena cava aneurysms are very rare mediastinal masses, classified as fusiform or saccular. These lesions are difficult to diagnose, and the optimal treatment strategy remains controversial. We present the case of an asymptomatic 54-year-old woman with an upper mediastinal mass. Computed tomography (CT) and magnetic resonance imaging showed a saccular aneurysm of the superior vena cava with a relatively large amount of intraluminal thrombus. Due to its tendency to enlarge, reconstruction of the superior vena cava with a fresh autologous pericardial patch was performed. Postoperatively, the patient experienced exertional shortness of breath, and CT showed a pulmonary thromboembolism, which resolved after anticoagulant therapy. In this report, we provide an update on the surgical management of patients undergoing treatment for superior vena cava aneurysms. Perioperative anticoagulation is considered important for mitigating the risk of pulmonary thromboembolism.