Aneurysm of the superior mediastinal veins

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Presentation transcript:

Aneurysm of the superior mediastinal veins Miralem Pasic, MD, PhD, Wolfdietrich Schöpke, MD, Paul Vogt, MD, Ludwig von Segesser, MD, Jakob Schneider, MD, Marko Turina, MD Journal of Vascular Surgery Volume 21, Issue 3, Pages 505-509 (March 1995) DOI: 10.1016/S0741-5214(95)70294-6 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Posteroanterior (A) and lateral (B) chest radiograms obtained with patient in supine position reveal broad-based right paratracheal mass lesion (arrowheads) measuring 10 cm in length × 4 cm in transverse dimension. Its superior margin contained irregular calcific density. Heart size and vascularity appear normal, and lungs are clear. Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Posteroanterior (A) and lateral (B) chest radiograms obtained with patient in supine position reveal broad-based right paratracheal mass lesion (arrowheads) measuring 10 cm in length × 4 cm in transverse dimension. Its superior margin contained irregular calcific density. Heart size and vascularity appear normal, and lungs are clear. Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Computed tomography examination of chest shows anterior mediastinal mass in expected location of thymus with dense calcifications (3 × 4 cm in. diameter) in its superior right aspect (arrowhead).B, Computed tomography scanning at level distal to calcified mass shows considerable dilation of upper mediastinal venous system (asterisk). Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Computed tomography examination of chest shows anterior mediastinal mass in expected location of thymus with dense calcifications (3 × 4 cm in. diameter) in its superior right aspect (arrowhead).B, Computed tomography scanning at level distal to calcified mass shows considerable dilation of upper mediastinal venous system (asterisk). Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Bilateral upper-extremity venogram confirmed diagnosis of saccular venous aneurysm of superior mediastinal veins. Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Intraoperative views show huge saccular venous aneurysm arising from proximal part of superior vena cava and both innominate veins; however, aneurysm is somewhat collapsed and only partially filled with blood because of venous drainage into heart-lung machine through cannula placed in left innominate vein. A In situ findings: A, represents venous aneurysm; ra represents right atrial appendage; rv represents right ventricle; p represents pulmonary artery; asterisk represents proximal part of ascending aorta, which is mostly covered with venous aneurysm. B, Aneurysmal sac is opened longitudinally; note clearly visible anatomic details. Venous cannula in left innominate vein is shown by white arrow; asterisk represents aortic cannula placed in ascending aorta; aneurysmal sac is shown by open arrow. Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Intraoperative views show huge saccular venous aneurysm arising from proximal part of superior vena cava and both innominate veins; however, aneurysm is somewhat collapsed and only partially filled with blood because of venous drainage into heart-lung machine through cannula placed in left innominate vein. A In situ findings: A, represents venous aneurysm; ra represents right atrial appendage; rv represents right ventricle; p represents pulmonary artery; asterisk represents proximal part of ascending aorta, which is mostly covered with venous aneurysm. B, Aneurysmal sac is opened longitudinally; note clearly visible anatomic details. Venous cannula in left innominate vein is shown by white arrow; asterisk represents aortic cannula placed in ascending aorta; aneurysmal sac is shown by open arrow. Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Specimen of removed calcified old parietal thrombus is partly covered by some fresh coagula (arrowheads). Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Histologic examination of specimen shown in Fig. 5; calcified thrombotic material transformed into lamellar bone (arrowheads). (Van Gieson-elastin; original magnification ×50.) Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Light microscopic examination of aneurysmal wall shows concentric layers of elastic laminae and collagenous fibers, but smooth muscle cells are absent. (Van Gieson-elastin; original magnification × 63.) Journal of Vascular Surgery 1995 21, 505-509DOI: (10.1016/S0741-5214(95)70294-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions