PMC10241565_01
Chest X
-
ray illustrates new right-sided plural effusion.
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She had undergone chest radiography that showed a new right-sided pleural effusion ( Fig. 1 ).
Preoperative 3D chest CT angiography.
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Her 3D chest computed tomography (CT) revealed a saccular azygos vein aneurysm measuring 7.7 cm x 5.8 cm (transverse x craniocaudal) without thrombus ( Fig. 2 ).
Schematic drawing of the cannulation and the aneurysm topography.
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The right brachiocephalic vein and SVC (proximal) were also snared ( Fig. 3 ).
Dissection of the aneurysm from the right phrenic nerve and the surrounding tissue (
A
), SVC posterior wall with multiple pretracheal vein's confluences. The aneurysm is depicted with a yellow arrow (
B
), and closure of SVC posterior wall after resection of pathological confluences (
C
).
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The aneurysmal wall was opened longitudinally ( Fig. 4A ). This thin-walled aneurysmal posterior wall with multiple pretracheal veins' confluences was subsequently resected and closed with 7-0 Prolene in interrupted fashion ( Fig. 4B, C ).
Augmentation of SVC anterior wall with autologous pericardial patch (depicted with a yellow arrow) (
A
) and SVC "wrapping" with acellular pericardial patch (depicted with a yellow arrow) (
B
).
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The resulting ventral wall defect was augmented with a fresh autologous pericardial patch ( Fig. 5A ). The outer surface of the reconstructed SVC was "wrapped" with an 18-mm-long acellular pericardial patch (Supple Peri-Guard, Lamed GmbH, Germany) to prevent the potential formation of pseudoaneurysms or a rupture relapse ( Fig. 5B ). 
Postoperative 3D chest CT angiography.
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CT at discharge showed a completely eliminated aneurysm and no evidence of relevant venous stenosis ( Fig. 6 ).