Korean Circ J.  2016 Mar;46(2):264-267. 10.4070/kcj.2016.46.2.264.

Complicated Azygos Vein Aneurysm in an Infant Presenting with Acute Pulmonary Thromboembolism

• Choi J
• Song J
• Huh J
• Kang IS
• Yang JH
• Jun TG

• KMID: 2344480
• DOI: http://doi.org/10.4070/kcj.2016.46.2.264

Abstract

Azygos vein aneurysm is a rare cause of mediastinal mass. Most cases present as an incidental finding on imaging modalities, but in few cases the thrombosis in the aneurysm leads to pulmonary thromboembolism, which may require surgical resection. We present a case where, for the first time, a case of a complicated azygos vein aneurysm was diagnosed in infancy, which required surgical resection.

Keyword

Azygos vein; Aneurysm; Pulmonary embolism; Infant; Mediastinal disease

MeSH Terms

Aneurysm*
Azygos Vein*
Humans
Incidental Findings
Infant*
Mediastinal Diseases
Pulmonary Embolism*
Thrombosis

Figure

• 

  Fig. 1 Initial chest radiograph showing bulky mass in right hemithorax and paraspinal area (arrowhead).

• 

  Fig. 2 Chest contrast computed tomography. (A) 10 cm sized cystic mass in right hemithorax and paravertebral space, and left pulmonary thromboembolism (white arrow). (B) Visible connection between the mass and the superior vena cava (black arrow). (C) Visible connection between the mass and the azygos vein aneurysm (white arrow).

• 

  Fig. 3 Abdomen ultrasound showing cystic mass connecting to superior vena cava. M: cystic mass (azygos vein aneurysm), SVC: superior vena cava.

• 

  Fig. 4 Chest contrast computed tomography at discharge (A) and postoperative 6 months follow-up (B) showed the complete removal of the previous mediastinal mass, and demonstration of the right upper bronchus.

Reference

1. Stern WZ, Bloomberg AE. Idiopathic azygos phlebectasia simulating mediastinal tumor. Radiology. 1961; 77:622–625.

2. Chiu SS, Lau S, Kam CK. Azygous vein aneurysm: CT scan follow-up. J Thorac Imaging. 2006; 21:66–68.

3. Kurihara Y, Nakajima Y, Ishikawa T. Case report: saccular aneurysm of the azygos vein simulating a paratracheal tumour. Clin Radiol. 1993; 48:427–428.

4. 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. 2012; 27:W91–W93.

5. Gnanamuthu BR, Tharion J. Azygos vein aneurysm--a case for elective resection. Heart Lung Circ. 2008; 17:62–64.

6. Ko SF, Huang CC, Lin JW, et al. Imaging features and outcomes in 10 cases of idiopathic azygos vein aneurysm. Ann Thorac Surg. 2014; 97:873–878.

7. Jain A, Blebea JS. Post-traumatic pseudoaneurysm of the azygous vein in a patient with azygous continuation. J Comput Assist Tomogr. 1994; 18:647–648.

8. Icard P, Fares E, Regnard JF, Levasseur P. Thrombosis of an idiopathic saccular azygos aneurysm. Eur J Cardiothorac Surg. 1999; 15:870–872.

9. Kurihara C, Kiyoshima M, Asato Y, et al. Resection of an azygos vein aneurysm that formed a thrombus during a 6-year follow-up period. Ann Thorac Surg. 2012; 94:1008–1010.

10. Ueda Y, Tokuno J, Shoji T, Huang CL. An azygos vein aneurysm resected by video-assisted thoracic surgery after preoperative evaluation of multidetector computed tomography. Interact Cardiovasc Thorac Surg. 2014; 18:135–136.

11. D'Souza ES, Williams DM, Deeb GM, Cwikiel W. Resolution of large azygos vein aneurysm following stent-graft shunt placement in a patient with Ehlers-Danlos syndrome type IV. Cardiovasc Intervent Radiol. 2006; 29:915–919.

12. 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; 19:1251–1254.

13. Weber HS. Transcatheter occlusion of an azygous vein aneurysm. Catheter Cardiovasc Interv. 2011; 77:99–102.