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Mediastinal widening in an adult is mostly nodal in origin. Occasionally vascular aneurysms may be the underlying cause, in which case the aorta or its branches are most frequently involved. Thoracic venous aneurysms, on the other hand, have been reported only in anecdotes, with fusiform aneurysm of the superior vena cava being the commonest. Isolated aneurysms involving the brachiocephalic/innominate vein are extremely rare. We describe detection of a saccular aneurysm of the innominate vein, as the underlying cause of mediastinal widening seen on a chest radiograph in a 42-year-old asymptomatic woman. The characteristic radiological findings of thoracic venous aneurysms are described with particular reference to the importance of multiplanar computed tomography in such settings. Also discussed is the role of imaging in the diagnosis ...
We study a case of a 65-year-old woman who developed popliteal arteriovenous fistula (AVF) and venous aneurysm following left knee arthrodesis. Presenting features included left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa and ankle. Left femoral angiography showed an AVF arising from the right tibioperoneal trunk and an aneurysm at the level of the AVF. Findings at open investigation included AVF between the tibioperoneal trunk and the popliteal vein, and a venous aneurysm arising from the popliteal vein opposite the neck of the arteriovenous communication. The aneurysm and fistula were repaired using prolene suture.
A 78 year old woman developed repeated major pulmonary emboli following nasal resection for recurrent basal cell carcinoma. Lower extremity venography performed prior to planned insertion of an inferior vena caval filter unexpectedly revealed a large thrombus-containing aneurysm of the proximal popliteal vein. The aneurysm was excised and the vein repaired by lateral suture. Anticoagulation was continued for 3 months postoperatively. There were no further episodes of pulmonary embolism and popliteal vein patency was confirmed by duplex ultrasound 3 months postoperatively. The literature pertaining to these rare popliteal venous aneurysms is reviewed.
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