Saccular Superior Vena Cava Aneurysm in a Patient with Recurrent Pulmonary Embolism

Superior vena cava (SVC) aneurysms are rare, and saccular variants carry a higher risk of thromboembolism. We report a 57-year-old man with three episodes of pulmonary embolism despite therapeutic anticoagulation, found to have a 3 × 3 cm saccular SVC aneurysm that had been overlooked on prior pulmonary embolism protocol imaging. He underwent off-pump surgical resection via median sternotomy with reconstruction using an extracellular matrix patch and recovered uneventfully. This case underscores the importance of careful multiplanar review in patients with unexplained recurrent pulmonary embolism and demonstrates the feasibility of off-pump resection with extracellular matrix reconstruction in selected patients.