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Open Access Highly Accessed Case Report

Superior vena cava syndrome in a patient with previous cardiac surgery: what else should we suspect?

Panagiotis Dedeilias1, Ioannis Nenekidis1, Panagiotis Hountis1, Christos Prokakis2, Paraskevi Dolou3, Efstratios Apostolakis2 and Efstratios N Koletsis2*

Author Affiliations

1 1st Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece

2 Department of Cardiothoracic Surgery, University of Patras, Greece

3 Department of Anaesthesiology, Evangelismos General Hospital, Athens, Greece

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Diagnostic Pathology 2010, 5:43  doi:10.1186/1746-1596-5-43

Published: 25 June 2010

Abstract

Background

Although mediastinal tumors compressing or invading the superior vena cava represent the major causes of the superior vena cava syndrome, benign processes may also be involved in the pathogenesis of this medical emergency. One of the rarest benign causes is a pseudoaneurysm developing in patients previously having heart surgery.

Case report

We present the case of a large pseudoaneurysm of the ascending aorta, five years after primary surgery, with a significant compression of the right mediastinal venous system causing superior vena cava syndrome, detected at chest CT angiography. Perioperative findings showed two rush out points both coming from the distal aortic suture line which was performed five years ago. The patient underwent reoperation under circulatory arrest facilitating safe exploration and repair of the distal anastomotic leaks

Conclusion

Enhanced chest CT should be always undertaken in all patients with superior vena cava syndrome, especially in those previously having cardiac or aortic surgery to correctly evaluate the presence of a pseudoaneurysm. Mass effect to the superior vena cava makes necessary an open surgical treatment of the pseudoaneurysm so as to concurrently resolve the right mediastinal venous system's compression. Surgery should be performed in terms of safe approach to avoid exsanguination and cerebral malperfusion.