Giant cephalic venous aneurysm

The occurrence of venous aneurysms (VAs) is very rare, and VAs have been seldom reported in the existing literature. The etiology leading to the formation of VAs has not yet been determined. The presentation can range from asymptomatic to painful thrombosis of the sac, with rare events of pulmonary embolism. We have reported the case of a patient who had had a large cephalic vein aneurysm that was treated successfully. A 39-year-old man had presented with swelling in the left forearm that had progressively increased in size for 2 years and was associated with discomfort. On examination, a 5 × 5-cm soft compressible lesion was present over the mid-forearm that disappeared with raising of the arm. Contrast-enhanced magnetic resonance imaging showed a well-defined lesion arising from the cephalic vein. Under local anesthesia, after proximal and distal ligation, the aneurysm was excised. The histopathologic examination showed a thinned out smooth muscle wall and multifocal absence of the smooth muscle layer. The patient was doing well at 1 year of follow-up with no further degeneration in the vein wall. The formation of VAs might result from endophlebohypertrophy and endophlebosclerosis of the veins at the site of recurrent stress. Surgical excision should be considered when the patient is symptomatic, cosmetic disfigurement is present, and/or complications such as venous thrombosis, pulmonary embolism, and/or nerve compression have developed.