Ann Thorac Surg 2000;70:665-666
© 2000 The Society of Thoracic Surgeons
Case report
Azygos vein diverticulum
Victor M. Caramutti, MDa,
Javier C. Zaidman, MDb,
José A. Abud, MDa,
Eduardo D. Gabe, MDb
a Department of Cardiovascular Surgery, Favaloro Foundation, Buenos Aires, Argentina
b Department of Clinical Cardiology, Favaloro Foundation, Buenos Aires, Argentina
Address reprint requests to Dr Gabe, Department of Clinical Cardiology, Favaloro Foundation, Belgrano 1746 (1093), Buenos Aires, Argentina
e-mail: gabe{at}cardioweb.net.ar
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Abstract
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A 47-year-old woman, diagnosed with a diverticulum of the arch of the azygos vein, underwent surgical treatment. With nonspecific symptomatology, she presented one of the most uncommon anomalies of the large veins.
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Introduction
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Venous diverticuli are uncommonly diagnosed and treated, probably due to absence or unspecificity of signs and symptoms on physical exam. Diverticulum of the inferior vena cava, jugular bulb, and, more recently, of the superior vena cava, have been described in the literature as truly rare occurrences [1–3]. In our hospital, we have come across and treated a 47-year-old female patient with one of the described lesions of the arch of the azygos vein.
At the time of the consult, the symptomatology was vague (progressive dizziness for 2 years). A radiodense image in the right upper hemithorax could be seen on a chest x-ray (Fig 1). The magnetic resonance image revealed a space occupying mass posteriorly, compatible with a saccular dilatation of the azygos vein. The diagnosis was confirmed with an angiogram using subtraction, which also specified the dimensions, origin, and tributaries of the lesion (Fig 2).
In order to approach the lesion, the patient underwent posterolateral thoracotomy through the fourth intercostal space under general anesthesia and selective intubation. The azygos vein resection extended between a site proximal to the origin of the diverticulum and the end of the arch of the azygos vein adjacent to its junction with the superior vena cava.
The postoperative period was uneventful. According to the pathology report, the resected sample showed no morphological alterations. The vessel wall of the sample had normal venous architecture, thus confirming the preoperative diagnosis of a saccular dilation.
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Comment
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Saccular dilatations or venous diverticuli are extremely rare. Nevertheless, in agreement with other authors [1–3], we believe that the presence of this particular pathology should be suspected with space-occupying masses on x-ray and magnetic resonance imaging, and confirmed with angiography. Furthermore, we believe that surgical treatment is indicated, even in asymptomatic patients, to prevent complications: caval rupture, obstruction, or future embolic events such as some episodes of pulmonary embolism of unknown cause.
The location of the arch of the azygos vein in the right tracheobronchial angle has been carefully described. The differential diagnosis of the azygos vein diverticulum should be done with other abnormal mediastinal masses and portal hypertension, right heart failure, and obstruction or absence of the inferior cava [4–6].
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References
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Hasan F., Gleeson F., Lock M.R., Williams R., Grant D. Diverticulum of the inferior vena cava. J Vasc Surg 1992;15:578-580.[Medline]
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Grahan M.D. The jugular bulb. Laryngoscope 1977;87:105-125.[Medline]
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Shadiro S., Izuru Y., Yashiro U. Diverticulum of the superior vena cava. Ann Thorac Surg 1994;58:890-891.[Abstract]
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Staufer H.M., La Bree J.W., Adams F.H. Normally situated arch of azygos vein. AJR Am J Roentgenol 1951;66:353.
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Seebauer L., Prauer H.W., Gmeinwieser J., Sebening F. A mediastinal tumor simulated by a sacculated aneurysm of the azygos vein. Thorac Cardiovasc Surg 1989;37:112-114.[Medline]
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Gaber Y., Schmeller W., Romer C., Heise S., Kummer-Kloess D. Pelvic and leg vein thrombosis in azygous and hemi-azygous vein continuity syndrome and complete agenesis of the inferior vena cava. Vasa 1998;27:187-191.[Medline]
Accepted for publication December 27, 1999.
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Abstract
Introduction
