HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen Wildhirt Lothar Eckel Friedhelm Beyersdorf Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wildhirt, S. Articles by Satter, P. Search for Related Content PubMed PubMed Citation Articles by Wildhirt, S. Articles by Satter, P.

J Thorac Cardiovasc Surg 1994;107:1535-1536
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Atherosclerotic aneurysm of the right internal mammary artery presenting as a mediastinal mass

Department of Thoracic and Cardiovascular Surgery
Johann Wolfgang Goethe-University
Frankfurt, Germany

To the Editor:

Vascular abnormalities are among the causes for anterosuperior mediastinal masses ^1,2 In particular, aneurysms of the systemic arterial system (thoracic aorta, subclavian artery) have to be considered. ³ We report the case of a 62-year-old white woman who underwent a cardiac operation for a left atrial myxoma in conjunction with an atherosclerotic aneurysm of the right internal mammary artery, to the best of our knowledge a previously unreported cause of an upper mediastinal mass.

A 62-year-old woman with a history of smoking and hypertension first appeared at our clinic in February 1989 with shortness of breath, weakness, dizziness, and intermittent right-sided chest pain in the second and third intercostal spaces. The routine electrocardiogram (ECG) and laboratory tests did not show any unusual signs. The chest x-ray film showed a well-defined calcified tumor with a maximum diameter of 4 cm in the right upper anterior mediastinum (Fig. 1). Computed tomographic scanning of the thorax revealed a circular formation with partial contrast enhancement indicating that the mediastinal mass was of vascular origin, such as an aneurysm of the right subclavian artery (Fig. 2). The patient was scheduled for an angiogram of the supraaortic arteries but did not keep her appointment.

View larger version (109K): [in this window] [in a new window]   Fig. 1. Posteroanterior chest x-ray film shows a calcified, well-defined tumor in the right upper anterior mediastinum.

View larger version (112K): [in this window] [in a new window]   Fig. 2. Contrast computed tomographic scan shows contrast medium enhancement in the mediastinal mass, suggesting a vascular process.

Before the cardiac operation was done for the left atrial myxoma, intravenous digital subtraction angiography was used for further differential diagnosis for the mediastinal mass. It showed a partially thrombosed tumor, most likely an aneurysm of the right subclavian artery. The patient was scheduled for an elective operation in February 1993.

After resection of the myxoma of the left atrium, a right pleuracotomy was performed. The tumor was visible but did not originate from the right subclavian artery; instead it was found to be an aneurysm of the right mammary artery. The aneurysm, the right mammary artery, and the phrenic nerve were prepared carefully. After double ligation of the distal and proximal parts of the mammary artery, the aneurysm was removed.

On histologic examination the resected, nonaneurysmal parts of the mammary artery showed severe atherosclerosis. The aneurysm was diagnosed as an atherosclerotic aneurysm of the right mammary artery, a previously unreported finding in the upper anterior mediastinum. Microscopic examination of the aneurysm and the mammary artery showed an enlarged intima with calcified and hyalinized connective tissue as well as fibrin and some lymphocytes.

The postoperative chest x-ray film showed normal heart size and mediastinum and the ECG showed regular sinus rhythm. The patient was discharged 12 days after the operation in good physical condition.

Previous reports referring to mammary artery abnormalities include posttraumatic arteriovenous fistulas, posttraumatic false aneurysms, fibromuscular hyperplasia, and atherosclerotic disease. ^1-5 However, the internal mammary artery is remarkably resistant to the development of atherosclerosis, ^1,6 and progression of the atherosclerotic process in the mammary artery to a true aneurysm has not been described in the reviewed literature. This case of unilateral atherosclerotic internal mammary artery aneurysm is an unusual and, to the best of our knowledge, a previously unreported cause of upper anterior mediastinal mass.

References

1. Giles JA, Sechtin AG, Waybill MM, Moser RP Jr. Bilateral internal mammary artery aneurysms: a previously unreported cause for an anterior mediastinal mass. Am J Roentgenol 1990;154:1189-90. [Free Full Text]
   
2. Spreafico P, Minzioni G, Grande AM, Rota L, Cornalba GP, Vigano M. False aneurysm of the internal mammary artery. J Cardiovasc Surg (Torino) 1991;32:62-3. [Medline]
   
3. Kelley MJ, Mannes EJ, Ravin CE. Mediastinal masses of vascular origin: a review. J THORAC CARDIOVASC SURG 1978;76:559-72. [Abstract]
   
4. Den Otter G, Stam J. Aneurysm of internal mammary artery. Thorax 1978;33:526-7. [Abstract]
   
5. Millner RW, Guvendig L, Blauth C, Treasure T, Pepper JR. False aneurysm of the right internal mammary artery. Ann Thorac Surg 1991;51:831-2. [Abstract]
   
6. Shelton ME, Mervyn FB, Virmani R. A comparison of morphologic and angiographic findings in long-term internal mammary artery and saphenous vein bypass grafts. J Am Coll Cardiol 1988;11:297-307.[Abstract]
   

This article has been cited by other articles:

				G. H. Almassi Internal thoracic vein aneurysm presenting as an anterior mediastinal mass J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 500 - 501. [Full Text] [PDF]

				Y. Hachiro, S. Sugimoto, N. Takagi, and T. Abe Aneurysmal change in an internal mammary artery-pulmonary artery fistula Ann. Thorac. Surg., October 1, 2001; 72(4): 1377 - 1378. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen Wildhirt Lothar Eckel Friedhelm Beyersdorf Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wildhirt, S. Articles by Satter, P. Search for Related Content PubMed PubMed Citation Articles by Wildhirt, S. Articles by Satter, P.