Abstract
Superior vena cava (SVC) aneurysms are exceedingly rare vascular abnormalities with only limited cases reported in the literature, and their natural history and optimal management remain poorly defined, particularly in asymptomatic patients. We present the case of a 75-year-old male with an incidental finding of a fusiform SVC aneurysm on computed tomography (CT). In the absence of symptoms, he was managed conservatively with anticoagulation to minimize thromboembolic risk and serial CT follow-up. Given the rarity of these lesions and the lack of standardized management guidelines, decisions regarding intervention must carefully weigh the risks of rupture and thromboembolic events against the morbidity associated with surgical repair. In this case, close monitoring with anticoagulation proved to be an appropriate strategy, emphasizing the need for individualized, risk-based management. This case highlights the importance of vigilance and long-term surveillance in patients with incidentally discovered SVC aneurysms, with conservative management and serial imaging serving as a safe option for asymptomatic individuals with stable aneurysm dimensions.