LAUSR

Background And Aim: We present a rare case of SVC saccular aneurysm in a 60 year-old-female presenting at outpatient clinic with chest pain due to a recent chest trauma and occasional finding of mass at chest radiography. Considering the small amount of similar cases collected in literature we describe the diagnosis iter, surgical management and outcomes. Methods: Chest CT-scan was done with contrast showing a contrast filled mass adjacent to the ascending aorta (40 mm × 60 mm -neck diameter 30 mm). Off pump surgery was performed by SVC saccular aneurysm excision through a median sternotomy. After the pericardial incision and longitudinal right pleura opening to dissect the saccular aneurysm, the neck of the sac was encircled with silk 0 to exclude the aneurysm. After opening of the aneurismatic wall the aneurysm was resected and the aneurysmatic neck closed with a 4/0 prolene double running suture. Results: After an uneventful postoperative period of 24 hours in ICU the patient was discharged in 5th postoperative day on antiplatelet drugs. Ct-scan after surgery showed a regular profile of superior vena cava. Conclusions: CT scan is crucial to identify a contrast enhancing lesion adjacent to the ascending aorta. Fusiform aneurysm can be managed medically while saccular aneurysm needs surgical treatment in order to avoid complications due to pulmonary embolism and aneurysm rupture. Surgery can be performed safely off pump in case of not complicated aneurysm while has to be managed on pump in presence of thrombi, calcification or big neck dimension related to the aneurysmatic sac.