• Paolo Albino Ferrari, Federico Fusaro, Antonio Ferrari, Alessandro Tamburrini, Giulia Grimaldi, Massimiliano Santoru, Sara Zappadu, Elisabetta Tanda, Sonia Nemolato, Simone Comelli, and Roberto Cherchi.
• Division of Thoracic Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione "G. Brotzu", 09121 Cagliari, Italy.
• Medicina (Kaunas). 2022 Dec 31; 59 (1).

BackgroundMediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of treatment remains controversial.Case PresentationHerein, we report the case of a hemangioma of the azygos vein arch in a 66-year-old woman who presented with dyspnea, chest discomfort, dysphagia, and weight loss. A simultaneous right chylothorax refractory to conservative management was found. A CT-guided biopsy of the mass was performed, and it confirmed the vascular nature of the lesion. Therefore, the patient underwent an angiography followed by endo-vascular embolization. Three days later, thoracoscopic surgical resection of the mass and the repair of the chyle leakage were performed safely. The patient was discharged uneventfully on postoperative day seven, with complete resolution of all the presenting symptoms.ConclusionsTreatment of symptomatic mediastinal hemangiomas could be mandatory, but a thorough multidisciplinary approach to these rare malformations is essential. Despite the risk of intraoperative bleeding, selective endovascular embolization followed by thoracoscopic surgery allowed for a complete and safe resection with a good outcome.

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