2023 Volume 37 Issue 5 Pages 455-460
A 79-year-old woman underwent chest computed tomography (CT) after a traffic accident. CT revealed an anterior mediastinal nodule suspected to be a thymic epithelial tumor, and she was referred to our hospital for surgery. Chest contrast CT showed left brachiocephalic vein hypoplasia and a collateral vein flowing into the accessory hemiazygos vein. Video-assisted thoracoscopic thymectomy was performed via a right thoracic approach. The narrow left brachiocephalic vein and very narrow anomalous vessels were identified, running from the upper left lobe of the thymus. Only the thymic veins were cut, and the tumor and thymus were resected. The pathological diagnosis was thymoma of type B2 (Masaoka stage I). The postoperative course was uneventful, and she was discharged on day 5 postoperatively.
In adults without cardiac malformation, anomaly of the left brachiocephalic vein is rare. However, in those with these anomalies, there are some risks of injury when performing thymus dissection or misidentifying the left brachiocephalic vein as the thymic vein. Therefore, care should be taken when checking pre-operative CT. In this case, pre-operative contrast CT revealed vessel abnormalities, which enabled safe resection of the tumor.
