The Azygos Vein From A to Z

Peripherally inserted central catheter malposition into the azygos vein: A case series report and review of the literature

BACKGROUND

Peripherally inserted central catheters (PICCs) are frequently utilized for extended intravenous treatments. However, complications such as incorrect placement into the azygos vein can result in significant health issues. A thorough understanding of these aspects is crucial to enhance the safety and effectiveness of PICC procedures, thereby improving patient care outcomes.

METHODS

The research was conducted on a cohort of 12 patients who experienced PICC malposition into the azygos vein. Systematically reviewed information on classification, imaging manifestations, potential influencing factors, and methods for identification, prevention, and management.

RESULTS

The analysis uncovered two PICC malposition classifications within the azygos vein, each with unique imaging characteristics. It also pinpointed several factors influencing malposition, offering valuable insight into potential risks. Moreover, it established effective detection methods, underscoring the significance of imaging techniques. Additionally, it outlined strategies for preventing and managing PICC malposition in the azygos vein, enhancing overall comprehension of the issue.

CONCLUSIONS

The findings emphasize the importance of taking a proactive stance to avoid malposition and stress the necessity of prompt and precise intervention when malposition does happen, thereby enhancing the safety and effectiveness of PICC processes.

Dilated Accessory Hemiazygos Vein Mimicking Aortic Dissection in Setting of Absent Left Brachiocephalic Vein

Although uncommon, aortic dissection can be rapidly fatal with a 20% out-of-hospital mortality which increases at a rate of 1 to 3% every hour [1]. An expeditious diagnosis of acute aortic dissection is therefore imperative. One of the most advantageous diagnostic modalities utilized in the setting of acute aortic dissection is a transesophageal echocardiogram (TEE). In an acute setting, TEE is preferred because of its ability to provide a timely and definitive diagnosis [2]. Despite its diagnostic convenience, clinicians must be aware that there are several entities that may mimic aortic dissection. One of these entities includes a dilated accessory hemiazygos vein. In this report, we present a case of a 66-year-old woman who was found to have a possible Stanford type B dissection in the descending thoracic aorta on a TEE exam in the context of work up prior to an elective electrophysiology study and ablation for paroxysmal atrial fibrillation. CT angiography, however, revealed a dilated accessory hemiazygos vein, a rare congenital vascular anomaly that could potentially mimic aortic dissection leading to misdiagnosis and potentially unnecessary interventions.