J Korean Med Sci.  2011 May;26(5):690-693. 10.3346/jkms.2011.26.5.690.

Unusual Cause of Acute Right Ventricular Dysfunction: Rapid Progression of Superior Vena Cava Aneurysm Complicated by Thrombosis and Pulmonary Thromboembolism

• Oh SG
• Kim KH
• Seon HJ
• Yoon HJ
• Ahn Y
• Jeong MH
• Cho JG
• Park JC
• Kang JC

• KMID: 1777872
• DOI: http://doi.org/10.3346/jkms.2011.26.5.690

Abstract

Aneurysms of the major thoracic veins are rare. They are usually asymptomatic and thus treated conservatively. We report an extremely rare case of rapidly progressing superior vena cava (SVC) aneurysm complicated by thrombosis and acute pulmonary thromboembolism (PTE) with right ventricular dysfunction. Thrombolytic therapy for hemodynamically significant acute PTE was harmful to the patient in the present case, because it induced further thrombosis and mobilization of the thrombi within the aneurysm, subsequently causing de novo PTE. Surgical aneurysmectomy combined with pulmonary artery embolectomy would be a treatment of choice in patients with SVC aneurysm complicated by acute PTE.

Keyword

Aneurysm; Vena Cava, Superior; Pulmonary Embolism

MeSH Terms

Abdominal Pain
Amyloidosis/complications/*pathology
Biopsy
Diagnosis, Differential
Endoscopy
Humans
Inflammatory Bowel Diseases/diagnosis
Intestine, Small/*pathology
Lymphoma, B-Cell, Marginal Zone/complications/*pathology
Male
Middle Aged

Figure

• 

  Fig. 1 Serial radiographic changes of the superior vena cava (SVC) aneurysm. Chest radiography at 2 yr ago (A) and 1 month (B) ago revealed the SVC aneurysm without any changes in size. The SVC aneurysm was markedly increased in size on chest radiography at admission (C) and disappeared after surgery (D).

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  Fig. 2 Multiplanar reformat images (A, B) and three-dimensional volume rendered images (C, D) of chest computed tomographic angiography demonstrated the superior vena cava (SVC) aneurysm with internal thrombi (★) protruding into the SVC through the narrow neck (arrow head in A and D) and pulmonary arterial embolism (arrow heads in B).

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  Fig. 3 A giant saccular aneurysm with internal thrombi formation arising from the superior vena cava was shown on surgical fields (A). On histopathologic examination, the aneurysmal wall contained all three layers of vascular wall, indicating true aneurysm (B).

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