Ann Thorac Surg 2010;89:987. doi:10.1016/j.athoracsur.2009.06.040
© 2010 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Aneurysm of Right Superior Pulmonary Vein
Tetsuhiko Go, MDa,
Teresa Maria de Caralt, MD, PhDb,
Paolo Macchiarini, MD, PhDa,*
a Department of General Thoracic and Regenerative Surgery and Intrathoracic Biotransplantation, University Hospital Careggi, Florence, Italy
b Department of Radiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
* Address correspondence to Dr Macchiarini, Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, 170 Villaroel, Barcelona, 08036, Spain (Email: pmacchiarini{at}clinic.ub.es).
A 62-year-old woman with a past medical history including successful cardiac ablation therapy for supraventricular paroxistic arrhythmia 8 years prior was admitted to the hospital with a history of progressive dyspnea and multiple chest pain episodes. On admission, the patient referred oppressive chest pain irradiated to the right shoulder and shortness of breath; her chest roentgenogram showed a right para-hiliar mass. A three-dimensional reconstruction of gadolinium-enhanced magnetic resonance angiography volume rendering (Fig 1A) and sub-volume maximum intensity projection (Fig 1B) demonstrated a right superior pulmonary vein aneurysm. The patient underwent a resection through a right muscle-sparing thoracotomy. The aneurysm was located totally extrapericardially and had no relation to the cardiac chambers. After its complete excision, revascularization of the right superior pulmonary vein continuity was made by an end-to-end anastomosis. The final pathology, coupled with the intraoperative findings, showed a primary aneurysm that was suggestive of a primary aneurysmatic right superior pulmonary vein without any relation to the previous ablation. The postoperative course was uneventful. At the patient's 12-month follow-up she is symptom-free and a new three-dimensional gadolinium-enhanced magnetic resonance angiographic scan (Fig 2) showed a patent anastomosis and no recurrence of aneurysm.
