Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

Case characteristics

An 82-year-old woman presented with acute onset back pain, dyspnea and engorged neck veins.

Clinical diagnosis

Dyspnea of twelve hours duration and engorged neck veins, later were found to be caused by superior vena cava syndrome from superior vena cava (SVC) compression by a giant saphenous vein grafts (SVG) pseudoaneurysm.

Differential diagnosis

Any cause for acute onset back pain and dyspnea such as acute coronary syndrome, pulmonary embolism, aortic dissection, etc.

Laboratory diagnosis

Lab tests result including cardiac enzymes were unremarkable.

Imaging diagnosis

Multi-imaging modalities including computed tomography chest angiogram, coronary angiogram and TEE revealed a giant bilobed SVG pseudoaneurysm to the right posterior descending artery causing compression of the superior vena cava leading to SVC syndrome.

Treatment

Surgical ligation and excision of the SVG pseudoaneurysm with regrafting of right posterior descending artery.