CLINICAL IMAGES PEER REVIEWED | OPEN ACCESS

www.edoriumjournals.com

International Journal of Case Reports and Images (IJCRI)International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.

Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.

IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.

Website: www.ijcasereportsandimages.com

A case of idiopathic azygos vein aneurysm

Adrian Iordache, Mary Bernadette Stevenage, Javed Sultan, Andrew Carne

ABSTRACT

Abstract is not required for Clinical Images

(This page in not part of the published article.)

International Journal of Case Reports and Images, Vol. 6 No. 12, December 2015. ISSN – [0976-3198]

Int J Case Rep Images 2015;6(12):786–788. www.ijcasereportsandimages.com

Iordache et al. 786

CASE REPORT OPEN ACCESS

A case of idiopathic azygos vein aneurysm

Adrian Iordache, Mary Bernadette Stevenage, Javed Sultan, Andrew Carne

Case report

A 93-year-old male presented to the emergency department with a few day history of worsening cough and shortness of breath. Examination showed a mildly raised JVP and scattered bilateral lung crepitations. A plain chest film confirmed cardiomegaly and signs of pulmonary congestion. Blood tests were generally unremarkable. Patient was given oxygen and started on Furosemide however due to on-going hypoxia a CT pulmonary angiogram was performed and ruled out pulmonary emboli however revealed a vascular abnormality which had 5x3 cm sac situated behind the trachea at the level of the bifurcation, consistent with a large azygos vein aneurysm (Figure 1).

The patient’s symptoms gradually improved over the coming days and he was eventually discharged home on Furosemide. The vascular abnormality was managed conservatively and is felt to be an incidental finding that requires no dedicated follow-up in this particular case given the patient’s age and co-morbidities.

Adrian Iordache1, Mary Bernadette Stevenage1, Javed Sultan2, Andrew Carne3

Affiliations: 1MBBS, FY1 Doctor, Department of Surgery, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom; 2MBBS MD FRCSed, Consultant Oesophago-gastric Surgeon, Department of Surgery, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom; 3MBBS FRCR, Consultant Radiologist, Department of Radiology, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom.Corresponding Author: Adrian Iordache, Surgery Department, Upper GI secretary office, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom, GU2 7XX; Email: adrian.iordache@nhs.net

Received: 08 October 2015Accepted: 04 November 2015Published: 01 December 2015

CliNiCAl imAgES PEER REviEwEd | OPEN ACCESS

DIsCUssIoN

Aneurysms of the azygos vein are rare findings and the aetiology is often unclear. They can be idiopathic or can occur in patients with congenital malformation of the inferior vena cava or more commonly secondary to high central venous pressures due to heart failure or portal hypertension [1]. Patients are usually asymptomatic however if the aneurysm gradually becomes enlarged, it can cause pressure effects on adjacent structures such as the superior vena cava or the right main bronchus. Patients with this pathology are often identified after having a chest radiograph that shows an incidental paratracheal density, mimicking a mediastinal mass. The size of the aneurysm may fluctuate with respiration, especially if a chest radiograph is taken whilst the patient performs the Valsalva maneuver. Contrast enhanced cross-sectional imaging is important in establishing its

Figure 1: Computed tomography pulmonary angiogram showing an azygos aneurysm arising from the SVC with a 5x3 cm sac (arrow) situated behind the trachea at the level of the bifurcation displacing the esophagus to the left.

International Journal of Case Reports and Images, Vol. 6 No. 12, December 2015. ISSN – [0976-3198]

Int J Case Rep Images 2015;6(12):786–788. www.ijcasereportsandimages.com

Iordache et al. 787

vascular nature so as to prevent potentially hazardous diagnostic procedures such as endobronchial ultrasound-guided transbronchial needle aspiration. There is no consensus as for the management of azygos aneurysms. It is generally felt that conservative management with long-term follow-up is most appropriate if the aneurysm is asymptomatic and uncomplicated, however surgical resection should be considered if the patient starts experiencing compression symptoms or the aneurysm develops intra-luminal thrombosis or thromboembolic disease (especially in the case of saccular aneurysms which pose a greater risk of complications) [2, 3]. Endovascular therapy can be considered as a successful alternative to surgery. However few cases have been documented in literature given the low prevalence of this pathology [4].

CoNCLUsIoN

Azygos vein aneurysms are rare occurrences and are often diagnosed incidentally. Conservative management with long-term follow-up is usually indicated if the aneurysm is uncomplicated.

Keywords: Azygos vein, Aneurysm, Vascular abnormal-ity

How to cite this article

Iordache A, Stevenage MB, Sultan J, Carne A. A case of idiopathic azygos vein aneurysm. Int J Case Rep Images 2015;6(12):786–788.

doi:10.5348/ijcri-201538-CL-10093

*********

author ContributionsAdrian Iordache – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be publishedMary Bernadette Stevenage – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be publishedJaved Sultan – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be publishedAndrew Carne – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

GuarantorThe corresponding author is the guarantor of submission.

Conflict of InterestAuthors declare no conflict of interest.

Copyright© 2015 Adrian Iordache et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.

reFereNCes

1. Gallego M, Mirapeix RM, Castañer E, Domingo C, Mata JM, Marín A. Idiopathic azygos vein aneurysm: a rare cause of mediastinal mass. Thorax 1999 Jul;54(7):653–5.

2. Ko SF, Huang CC, Lin JW, et al. Imaging features and outcomes in 10 cases of idiopathic azygos vein aneurysm. Ann Thorac Surg 2014 Mar;97(3):873–8.

3. Kurihara C, Kiyoshima M, Asato Y, al. Resection of an azygos vein aneurysm that formed a thrombus during a 6-year follow-up period. Ann Thorac Surg 2012 Sep;94(3):1008–10.

4. Irurzun J, de España F, Arenas J, García-Sevila R, Gil S. Successful endovascular treatment of a large idiopathic azygos arch aneurysm. J Vasc Interv Radiol 2008 Aug;19(8):1251–4.

International Journal of Case Reports and Images, Vol. 6 No. 12, December 2015. ISSN – [0976-3198]

Int J Case Rep Images 2015;6(12):786–788. www.ijcasereportsandimages.com

Iordache et al. 788

Access full text article onother devices

Access PDF of article onother devices

EDORIUM JOURNALS AN INTRODUCTION

Edorium Journals: On Web

About Edorium JournalsEdorium Journals is a publisher of high-quality, open ac-cess, international scholarly journals covering subjects in basic sciences and clinical specialties and subspecialties.

Edorium Journals www.edoriumjournals.com

Edorium Journals et al.

Edorium Journals: An introduction

Edorium Journals Team

But why should you publish with Edorium Journals?In less than 10 words - we give you what no one does.

Vision of being the bestWe have the vision of making our journals the best and the most authoritative journals in their respective special-ties. We are working towards this goal every day of every week of every month of every year.

Exceptional servicesWe care for you, your work and your time. Our efficient, personalized and courteous services are a testimony to this.

Editorial ReviewAll manuscripts submitted to Edorium Journals undergo pre-processing review, first editorial review, peer review, second editorial review and finally third editorial review.

Peer ReviewAll manuscripts submitted to Edorium Journals undergo anonymous, double-blind, external peer review.

Early View versionEarly View version of your manuscript will be published in the journal within 72 hours of final acceptance.

Manuscript statusFrom submission to publication of your article you will get regular updates (minimum six times) about status of your manuscripts directly in your email.

Our Commitment

Most Favored Author programJoin this program and publish any number of articles free of charge for one to five years.

Favored Author programOne email is all it takes to become our favored author. You will not only get fee waivers but also get information and insights about scholarly publishing.

Institutional Membership programJoin our Institutional Memberships program and help scholars from your institute make their research accessi-ble to all and save thousands of dollars in fees make their research accessible to all.

Our presenceWe have some of the best designed publication formats. Our websites are very user friendly and enable you to do your work very easily with no hassle.

Something more...We request you to have a look at our website to know more about us and our services.

We welcome you to interact with us, share with us, join us and of course publish with us.

Browse Journals

CONNECT WITH US

Invitation for article submissionWe sincerely invite you to submit your valuable research for publication to Edorium Journals.

Six weeksYou will get first decision on your manuscript within six weeks (42 days) of submission. If we fail to honor this by even one day, we will publish your manuscript free of charge.

Four weeksAfter we receive page proofs, your manuscript will be published in the journal within four weeks (31 days). If we fail to honor this by even one day, we will publish your manuscript free of charge and refund you the full article publication charges you paid for your manuscript.

This page is not a part of the published article. This page is an introduction to Edorium Journals and the publication services.