Pulmonary venous aneurysm presenting as a mediastinal mass in ischemic cardiomyopathy

True aneurysm of the pulmonary vein is a rare lesion and may present as a mediastinal mass. Acquired aneurysm of the right superior pulmonary vein presenting as a middle mediastinal mass in a patient with ischemic cardiomyopathy associated with severe mitral regurgitation and dilated left atrium is described. Though the natural history of this lesion is uncertain, it may progressively enlarge and become symptomatic. Presence of this lesion in this patient with cardiomyopathy may require a modification of surgical technique at cardiac transplantation or surgical resection of an aneurysm without cardiopulmonary bypass.