Pseudoaneurysm of the ascending aorta constitutes a well known entity after thoracic aortic surgery. We present a rare case of a large pseudoaneurysm created five years after primary surgery that provokes a significant compression of the right mediastinal venous system causing superior vena cava syndrome. Perioperative findings showed two rush out points both coming from the distal aortic suture line which was performed five years earlier. The patient underwent reoperation under circulatory arrest facilitating safe exploration and repair of the distal anastomotic leaks
