J Ped Surg Case Reports 13 (2016) 25e27

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Journal of Pediatric Surgery CASE REPORTS

journal homepage: www.jpscasereports.com

A great saphenous vein aneurysm in a child: A rare disorder

misdiagnosed as an inguinal hernia
Naoko Komatsuzaki a, b, *, Naoki Hashizume b, Yoshio Watanabe a, Hidemi Takasu a,
Wataru Sumida a, Kazuo Oshima a, Minoru Yagi b
a
Department of Pediatric Surgery, Aichi Children’s Health and Medical Center, 7-426, Morioka-cho, Obu, Aichi 474-8710, Japan
b
Department of Pediatric Surgery, Kurume University School of Medicine, Fukuoka, Japan

a r t i c l e i n f o a b s t r a c t

Article history: We report a case of primary great saphenous vein aneurysm (GSVA) in a 3 years old girl. A growing mass at
Received 17 February 2016 the right groin region had been detected in the upright position during the last two years, which was
Received in revised form misdiagnosed as inguinal hernia at the referral hospital. The Doppler ultrasound scanning (DUS) showed
1 March 2016
the findings of GSVA such as the 2 cm soft cystic mass from the great saphenous vein accompanying with
Accepted 1 March 2016
the turbulence flow, whereas with no vein thrombosis. GSVA was resected after the ligation of the distal
part of the great saphena vein. There was no sign of the recurrence in 1-year follow up at the outpatient
examination. Primary GSVAs are rare lesion and were often misdiagnosed and confused as soft tissue tumor
Key words:
Great saphenous vein aneurism
or inguinal hernia (J.S. de Miranda et al., 2015; G.A. Ranero-Juárez et al., 2005). As the diagnostic imaging for
Vascular malformation GSVAs, DUS is therefore effective in detecting the aneurysms and the presence of a thrombus.
Inguinal hernia Ó 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Venous aneurysms are defined as a solitaly area of venous
dilatation, not associated with hemangiomas, arteriovenous
communication or pseudoaneurysms. Primary great saphenous
vein aneurysms (GSVA) are rare lesion and be difficult to diagnosis,
which often be misdiagnosed as soft tissue mass or as inguinal
hernia [1,2]. We report a case of a primary great saphenous vein
aneurysm in a girl.
1. Case report
A 3-year-old girl was admitted to our hospital with a growing
mass in the right groin region that had been present for two years.
The mass was misdiagnosed as an inguinal hernia at the referring
hospital (Fig. 1). The mass increased in size during straining and
returned to the normal size in the supine position. The left groin
region was absolutely normal. There was no history of trauma,
infection and inflammatory disease. Doppler ultrasound scanning
(DUS) showed a soft cystic mass of 2 cm in size extending from the
great saphenous vein accompanied by turbulent flow. Thrombosis
was not observed (Fig. 2). Magnetic resonance angiography with
* Corresponding author. Department of Pediatric Surgery, Kurume University
School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan. Tel.: þ81
942 31 7631; fax: þ81 942 31 7705.
E-mail address: nkkmtzk03@med.kurume-u.ac.jp (N. Komatsuzaki).
the patient in the supine position did not show similar findings.
Based on several characteristics that were observed in the clinical
examination of the growing mass, a great saphenous vein aneurysm
(GSVA) was suggested.
Exploratory surgery was performed. A 2-cm incision was made
at the site of the saphenofemoral junction. The mass, an aneurysm
of the great saphenous vein was located approximately 5 mm from
the femoral vein. The aneurysm was resected after the ligation of
the distal part of the great saphenous vein (Fig. 3). A histopatho-
logical examination revealed the thickening of the focal intimal and
medial layers with areas of fibroplasia (Fig. 4).
Her postoperative course was uneventful and there was no sign
of the recurrence in the 1-year follow-up period.
2. Discussion
Venous aneurysms occur in every part of the body regardless of
age and gender [3]. Primary venous aneurysms are generally
congenital and develop from defective venous tissue. This disorder
occurs in young patients, often in association with Klippele
Trenaunay syndrome, which is known to be accompanied by a high
incidence of thromboembolism [4]. On the other hand, secondary
or acquired venous aneurysms are usually observed in adult pa-
tients and are associated with trauma, inflammation, connective
tissue deformation and degenerative changes. The young child in

2213-5766/Ó 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
http://dx.doi.org/10.1016/j.epsc.2016.03.001
26 N. Komatsuzaki et al. / J Ped Surg Case Reports 13 (2016) 25e27
Fig. 1. The clinical presentation of the growing mass in the right groin region.
the present case did not have any of the characteristic findings of
KlippeleTrenaunay syndrome, thus the exact cause of her GSVAs is
unknown.
GSVAs are classified into 4 types based on their location [5]:
Type I (52%) aneurysms are located at the proximal third of the
saphenous vein, but not at the saphenofemoral junction, Type II
(35%) aneurysms are located in the shaft of the saphenous vein in
the distal third of the thigh, Type III (7%) aneurysms include su-
perficial saphenous vein aneurysms in the same locations as types I
and II, Type IV (6%) include superficial venous aneurysms of the
short saphenous system. Superficial venous aneurysms such as type
III and IV are associated with saphenous vein reflux in both males
and females, whereas the lower-limb or deep system aneurysms are
have been associated with deep venous thromboses and pulmonary
embolisms [6,7]. The present case was classified as type IV.
Fig. 2. Doppler ultrasound scans showing a 2-cm cystic mass extending from the great
saphenous vein with turbulent flow.
Fig. 3. The intraoperative findings revealed a great saphenous vein aneurysm in the
area of the right saphenofemoral junction.
MRI and enhanced computed tomography are not effective in
detecting GSVAs because they are performed with the patient in the
supine position. In the supine position, GSVAs shrink in size, which
makes them difficult to detect. In contrast, DUS can be performed
with the patient in the upright position. It is therefore effective in
detecting the aneurysms and the presence of thrombi [8]. Several
surgical procedures for GSVAs have been reported; the procedures
vary according to the location. These include: the ligation of the
vessel around GSVAs, venorrhaphy, resection with a vein graft and
tangential aneurysmectomy with lateral venorrhaphy [3]. The
appropriate surgical approach is determined based on the location
of the aneurysm. Aneurysm resection with venorrhaphy has
been associated with the subsequent early occlusion of the
Fig. 4. The histopathological findings revealed focal intimal and media layer thick-
ening with areas of fibroplasia.
 N. Komatsuzaki et al. / J Ped Surg Case Reports 13 (2016) 25e27
surgically-shaped vessel. Aneurysm resection with the simple
ligation of the vessel may therefore be preferable [1]. In the case of
superficial aneurysms such as the present case, vessel reconstruc-
tion is not usually required. The latter procedure was therefore
selected for the treatment of the present case.
In conclusion, we herein presented a rare case of a type IV GSVA
in a 3-year-old girl. GSVAs are often misdiagnosed as soft tissue
tumors or inguinal hernias. DUS is effective in detecting aneurysms
and thrombi in patients with GSVAs.
Funding source
There are no funding sources to report in association with study.
Financial disclosure statement
The authors declare no relevant financial relationships in asso-
ciation with this study.
Conflict of interest
The authors declare no conflicts of interest in association with
this study.
27
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