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Ann Thorac Surg 1997;64:1527-1528
© 1997 The Society of Thoracic Surgeons

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Correspondence

Giant Azygos Vein Varix

Mayfair Thoracic & Cardiovascular Surgery, SC, Mayfair Bank Tower, 2300 N Mayfair Rd, Suite 755, Milwaukee, WI 53226

To the Editor:

We read with great interest the report of a giant azygos vein varix by Podbielski and associates [1]. Fortuitously we had just had a similar case on April 9, 1997. This patient also had a right-sided mediastinal mass that was immediately adjacent to the trachea. We performed video thoracoscopy (Fig 1). The mass turned out to be an aneurysmal dilatation of the azygos vein. This was proved by dissecting the parietal pleura as well as aspirating blood that subsequently clotted. Not knowing the natural history of this in a 76-year-old woman, we elected to leave it alone as the patient was completely asymptomatic. We did not believe that we wanted to subject this patient to a thoracotomy. We report this case simply to augment the report of Podbielski and associates and provide a photograph of the thoracoscopic findings.

View larger version (109K): [in this window] [in a new window]   Fig 1. . Thoracoscopic view of dilated azygos vein.

Reference

1. Podbielski FJ, Sam AD, Halldorson AO, et al. Giant azygos vein varix. Ann Thorac Surg 1997;63:1167–8.[Abstract/Free Full Text]

Reply

Division of Cardiothoracic Surgery (M/C 958), Department of Surgery, The University of Illinois at Chicago, College of Medicine, Rm 515 Clinical Sciences N, 840 S Wood St, Chicago, IL 60612

To the Editor:

The azygos vein varix discovered by Drs Hatton and Manjoney during video-assisted exploration of a mediastinal mass represents, in our opinion, an opportunity missed for surgical excision. Although they rightly acknowledge the unknown natural history of this finding, variceal dilation of a central venous vessel with resultant turbulent blood flow, at least in theory, poses a potential for thrombus formation with subsequent pulmonary embolism or for rupture and exsanguination. Although open thoracotomy does add to morbidity, the patient had already undergone general anesthesia to facilitate video thoracoscopic exploration. We believe the most appropriate course of action would be thoracoscopic excision of the lesion with endoscopic stapling devices. Simple biopsy, or in this case aspiration, although confirming the diagnosis, still leaves one with a lesion of potential risk.

This article has been cited by other articles:

				T. D. Person, C. B. Komanapalli, H. Chaugle, P. H. Schipper, and M. S. Sukumar Thoracoscopic approach to the resection of an azygos vein aneurysm J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 230 - 231. [Full Text] [PDF]

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