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Signs and Symptoms of Chest Diseases |

Idiopathic Azygous Vein Aneurysm Mimicking a Mediastinal Mass

Khalid Mohammad*, MD; Mohammad Siddiqui, MD; Marcia Erbland, MD
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University of Arkansas for Medical Sciences, Little Rock, AR


Chest. 2012;142(4_MeetingAbstracts):987A. doi:10.1378/chest.1390494
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Abstract

SESSION TYPE: Miscellaneous Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: True aneurysmal dilatation of the azygous vein is a rare entity which has been reported in literature on only ten occasions. We report a case of idiopathic azygous aneurysmal dilation that was incidentally discovered on chest reontgenogram.

CASE PRESENTATION: An 83 year-old female patient was admitted to the hospital with generalized weakness ,hematemesis and leg cellulitis. On physical examination she was afebrile with a pulse of 106 bpm ,blood pressure of 155/60 mm Hg, respiratory rate of 18 breaths/min and oxygen saturation of 98 % on room air. Chest auscultation showed bilateral equal breath sounds. Laboratory studies demonstrated a hemoglobin and hematocrit of 4.4 gm/dL and 14.9 respectively. Chest X-ray showed a large right paratracheal mass .A contrast enhanced CT scan of the chest showed a large azygous arch aneurysm measuring 5.5 x 3.4 cm with normal appearance of other mediastinal vasculature.An echocardiogram showed normal left ventricular and right ventricular systolic function.There was no laboratory or imaging data to suggest portal hypertension. A vascular surgery evaluation recommended a conservative management of the aneurysm. The patient was treated for upper gastro-intestinal tract bleed and lower extremity cellulitis and discharged home with outpatient follow appointment.

DISCUSSION: Enlargement of the azygos vein can be due to an increase in central venous pressure, portal vein hypertension, azygos continuation of the inferior vena cava , a tumour or thrombus located in the inferior vena cava,post-traumatic pseudoaneurysm and pregnancy. These dilatations are directly related to high blood flow status of the azygos vein system as a collateral. The etiology of the azygos aneurysm was unknown, but since no history of high pressure in the azygos system or recent trauma were recorded despite extensive anamnesis, clinical and radiographic examination, it was assumed to be congenital. These aneurysm can enlarge and may lead to pressure effects on adjacent tissues, such as obstruction of the superior vena cava and compression of the right main bronchus or the right upper lobe bronchus. An appropriate therapeutic strategy is not clear,but most of the cases reported had a surgical resection done for symptoms or as part of diagnostic evaluation of a mediastinal mass.

CONCLUSIONS: Azygous vein aneursym should be part of the differntial diagnosis for mediastinal mass, and requires followup of the lesion is important as an azygos vein aneurysm may grow.

1) He J, Mao H, Li H, Zhu B, Chen J, Zhou Z.A Case of Idiopathic Azygos Vein Aneurysm and Review of the Literature . J Thorac Imaging. 2011 Jun 9

DISCLOSURE: The following authors have nothing to disclose: Khalid Mohammad, Mohammad Siddiqui, Marcia Erbland

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University of Arkansas for Medical Sciences, Little Rock, AR

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