A 41-year-old woman was referred to our clinic for an incidental X-ray finding of abnormal contour and widening of right border of mediastinum (Panel A, arrow). Even though the patient was reported to have right-sided clavicle fracture in a car accident 16 years ago, no complications were left. Physical examinations also revealed no abnormalities. Transthoracic echocardiography identified an abnormal communication between a circumscribed echolucent mass with no intracavity thrombus and brachiocephalic vein (Panel B, arrow; Supplementary data online, Movie S1). A further computerized tomography angiography (CTA) demonstrated a giant aneurysm arising from left-sided brachiocephalic vein, compressing the adjacent superior vena cava (Panels C and D, 5.7 × 4.0 cm in short-axis, arrow and asterisk; Supplementary data online, Movies S2 and S3). The patient received surgical intervention without cardiopulmonary bypass. After partial median sternotomy, the aneurysm-like mass was exposed at the surface of left-sided brachiocephalic vein and superior vena cava (Panel E). We performed complete aneurysm resection and the neck of the aneurysm was subsequently continuously sutured with 5-0 prolene. Post-operative CTA scan revealed the disappearance of the mediastinal aneurysm (Panel F) and the pathologic examination of the aneurysmal wall confirmed no existence of chronic vasculitis (Panel G). The patient recovered without complications and was discharged home on the fourth day later.

中文翻译：

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臂头静脉产生的巨大静脉瘤。

一名41岁的妇女因偶然X线检查发现轮廓异常和纵隔右边界变宽而被转到我们的诊所（图A，箭头）。即使该患者在16年前因车祸被报告患有右侧锁骨骨折，也没有留下任何并发症。体格检查也未发现异常。经胸超声心动图检查发现，无腔内血栓的外切回声半透明块与头颅静脉之间存在异常通讯（图B，箭头；在线补充数据，电影S1）。进一步的计算机断层摄影血管造影（CTA）显示左侧头臂脑静脉产生巨大动脉瘤，压迫相邻的上腔静脉（C和D组，短轴，箭头和星号为5.7×4.0 cm；在线补充数据，电影） S2和S3）。该患者接受了无心肺旁路手术治疗。在进行部分正中胸骨切开术后，在左侧头臂脑静脉和上腔静脉的表面暴露出动脉瘤样肿块（图E）。我们进行了完整的动脉瘤切除术，随后连续用5-0 continuously骨缝合动脉瘤的颈部。术后CTA扫描显示纵隔动脉瘤消失（图F），对动脉瘤壁的病理检查证实不存在慢性血管炎（图G）。该患者康复无并发症，并于第四天出院。动脉瘤样肿块暴露于左侧头臂静脉和上腔静脉表面（图E）。我们进行了完整的动脉瘤切除术，随后连续用5-0 continuously骨缝合动脉瘤的颈部。术后CTA扫描显示纵隔动脉瘤消失（图F），动脉瘤壁的病理检查证实不存在慢性血管炎（图G）。该患者康复无并发症，并于第四天出院。动脉瘤样肿块暴露在左侧头臂静脉和上腔静脉表面（图E）。我们进行了完整的动脉瘤切除术，随后连续用5-0 continuously骨缝合动脉瘤的颈部。术后CTA扫描显示纵隔动脉瘤消失（图F），动脉瘤壁的病理检查证实不存在慢性血管炎（图G）。该患者康复无并发症，并于第四天出院。术后CTA扫描显示纵隔动脉瘤消失（图F），动脉瘤壁的病理检查证实不存在慢性血管炎（图G）。该患者康复无并发症，并于第四天出院。术后CTA扫描显示纵隔动脉瘤消失（图F），动脉瘤壁的病理检查证实不存在慢性血管炎（图G）。该患者康复无并发症，并于第四天出院。