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Tamura K, Konishi Y, Tatsuishi W, Abe T. Reversed L-shaped incision for resection of a large azygos vein aneurysm: a case report. Surg Case Rep 2023; 9:83. [PMID: 37199798 DOI: 10.1186/s40792-023-01669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Azygos vein aneurysms are rare and asymptomatic in many cases. The management for these aneurysms is controversial, and there is no clear guideline or evidence-based threshold for surgical or interventional therapy. CASE PRESENTATION Herein, we report the case of a giant azygos vein aneurysm in a 78-year-old man that was treated with a reversed L-shaped incision. A 56 × 77 mm saccular azygos vein aneurysm was incidentally detected on computed tomography. Subsequently, surgical resection with interventional radiology and reversed L-shaped thoracotomy was performed. First, we performed coil embolization of the azygos vein aneurysm inflow. Next, a cardiopulmonary bypass was established through a reversed L-shaped sternotomy, and the aneurysm was excised. CONCLUSIONS In this case, surgical resection via reversed L incision was effective.
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Affiliation(s)
- Kazuki Tamura
- Department of Cardiovascular Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.
| | - Yasunobu Konishi
- Department of Cardiovascular Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Wataru Tatsuishi
- Department of Cardiovascular Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Tomonobu Abe
- Department of Cardiovascular Surgery, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
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Yao Y, Hu Q, Xie X, Liu C, Lei Y, Li X, Wang Y, Liu G, Yang Y, Luo L, Li J. Single-port thoracoscopic removal of an azygos vein aneurysm: a case report and literature review. J Cardiothorac Surg 2023; 18:29. [PMID: 36647165 PMCID: PMC9844024 DOI: 10.1186/s13019-023-02143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Azygos vein aneurysms (AVAs) are extremely rare. The majority of patients have no obvious clinical symptoms, so they are found by physical examination or by chance. There is limited clinical treatment experience that can be referred to, and there are no clear guidelines or research evidence standardizing the surgical and interventional therapy. Here, we report a patient with idiopathic AVA whose three-dimensional reconstruction of the tumor was completed before surgery. On the basis of three-dimensional reconstruction, single-port thoracoscopic resection of the AVA was successfully completed and reported for the first time. The previously reported cases are summarized to provide guidance for the diagnosis and treatment of patients with AVAs. CASE PRESENTATION A 56-year-old man was transferred to our hospital due to "dysphagia". The diagnosis of AVA was made after enhanced computed tomography, gastroscopy, fiberoptic bronchoscopy, and three-dimensional reconstruction. Congenital weakness or degenerative changes causes the vein walls to be extremely thin that the AVA had the risk of ruptur. Furthermore, the patient had symptoms of dysphagia, he received single-port thoracoscopic surgery. After the operation, his dysphagia disappeared. The postoperative pathology confirmed hemangioma. The patient was discharged 3 days after surgery without any complications. CONCLUSIONS AVAs are rare. Preoperative three-dimensional reconstruction can greatly help surgeons clarify the disease diagnosis, formulate the surgical plan, avoid damage to the surrounding vital organs, and reduce intraoperative bleeding. Thoracoscopic surgery to remove AVAs is difficult and has a high risk of bleeding, while more minimally invasive single-port thoracoscopic surgery is also safe and effective for the treatment of AVAs.
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Affiliation(s)
- Yi Yao
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Qiuxia Hu
- Department of Obstetrics and Gynecology, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Xiaoyang Xie
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Caiyang Liu
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Yu Lei
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Xiaoliang Li
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Yi Wang
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Gaohua Liu
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Yanhui Yang
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Lei Luo
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
| | - Ji Li
- Department of Cardiothoracic Surgery, The First People’s Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, 641000 Sichuan China
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Ikushima T, Ujiie H, Tsuneta S, Chiba R, Tabata Y, Fujiwara-Kuroda A, Hida Y, Kaga K, Wakasa S, Kato T. Presurgical assessment of flow variability in an azygos vein aneurysm using 4D-flow MRI. Gen Thorac Cardiovasc Surg 2022. [PMID: 35384592 DOI: 10.1007/s11748-022-01813-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/21/2022] [Indexed: 11/04/2022]
Abstract
Azygos vein aneurysm (AVA) is necessary to prevent pulmonary embolism due to the outflow of a thrombus or rupture of the aneurysm. However, there is no established modality to assess the properties of AVA. Time-resolved three-dimensional phase-contrast magnetic resonance imaging (4D-flow MRI) has been used to examine the hemodynamics in various fields. We report a case of AVA to evaluate the flow variability and adhesions of surrounding tissues using 4D-flow MRI. The findings of the study suggested aneurysm turbulence and the absence of thrombi. The cine image, which showed a sliding wall synchronized to the heartbeat, indicated no adhesion to the superior vena cava. Based on these results, the thoracoscopic approach was deemed possible preoperatively. Thoracoscopic AVA resection was performed, and the postoperative course was uneventful. This study documented the utility of 4D-flow MRI for a detailed evaluation of AVA.
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Savu C, Melinte A, Balescu I, Bacalbasa N. Azygos Vein Aneurysm Mimicking a Mediastinal Mass. In Vivo 2021; 34:2135-2140. [PMID: 32606194 DOI: 10.21873/invivo.12019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/12/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Azygos vein aneurysm (AVA) is a rare thoracic pathological entity that mimics a posterior mediastinal mass as well as a right paratracheal mass. Usually asymptomatic, AVA is often accidentally discovered during routine chest x-rays; however, depending on the aneurysm size and complications, some symptoms may be present. The aim of this paper is to report a case of idiopathic AVA and to discuss its aetiology, embryonic origin, symptoms, complications, diagnostic methods and treatments. CASE REPORT A 74-year-old female was investigated for diffuse thoracic pain and submitted to standard chest x-ray, which identified a right paratracheal, well-defined, homogenous opacity, considered to be part of the mediastinal shadow. The patient was further submitted to thoracic computed tomography, which confirmed the presence of a tumoral mass at the level of the right paratracheal area. The patient was submitted to surgery and the tumoral mass was resected; however, the tumor proved to be a completely thrombosed aneurism of the azygos vein arch. CONCLUSION AVA is a rare pathology that must be taken into consideration during the differential diagnosis of right postero-superior mediastinal masses.
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Affiliation(s)
- Cornel Savu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Melinte
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, "Ponderas Academic Hospital", Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, "Fundeni" Clinical Institute, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
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Morton S, Grubic AD, Ayazi S, Muluk SC, Fernando HC, Jobe BA. Multifactorial dysphagia: Azygos vein aneurysm (AVA) and esophagogastric junction outflow obstruction (EGJOO). Int J Surg Case Rep 2021; 83:106017. [PMID: 34090196 PMCID: PMC8188362 DOI: 10.1016/j.ijscr.2021.106017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Vascular impingement of the esophagus is a rare cause of dysphagia, and is most commonly due to aortic arch anomalies such as arterial lusoria. Dysphagia resultant from venous compression is even further less likely. Presentation of case We present a highly unusual case of dysphagia secondary to a large aneurysm of the azygous vein near its confluence with the superior vena cava, which was managed with endovascular modalities. Despite initial treatment success, patient reported some intermittent solid food dysphagia, and was also found to have esophagogastric junction outflow obstruction (EGJOO) on high resolution impedance manometry (HRIM) which was successfully managed with surgical myotomy and partial fundoplication. Discussion The azygos vein has an intimate anatomic relationship with the esophagus as it traverses the posterior mediastinum. Because of this anatomic association, the azygos vein may present a point of esophageal obstruction in the setting of significant pathology. Conclusion This case highlights the possibility of multifactorial causes of dysphagia, and that HRIM is a key aspect of this workup. Additionally we discuss the pertinent anatomy, diagnosis, and treatments for azygos vein aneurysm and EGJOO. Vascular impingement of the esophagus is a rare cause of dysphagia. This type of dysphagia is most commonly due to aortic arch anomalies such as arterial lusoria. The azygos vein may present a point of esophageal obstruction in the setting of significant pathology. Endovascular therapy in selected patients can provide resolution of dysphagia in patients with azygos vein aneurysm. There is possibility of multifactorial causes of dysphagia, and high resolution manometry is a key aspect of this workup.
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Affiliation(s)
- Scott Morton
- Esophageal Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Andrew D Grubic
- Esophageal Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Shahin Ayazi
- Esophageal Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, United States of America.
| | - Satish C Muluk
- Division of Vascular Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Hiran C Fernando
- Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Blair A Jobe
- Esophageal Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, United States of America
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Takamori S, Oizumi H, Utsunomiya A, Suzuki J. Thoracoscopic removal of an azygos vein aneurysm with thrombus formation. Gen Thorac Cardiovasc Surg 2021; 69:1335-7. [PMID: 34037949 DOI: 10.1007/s11748-021-01652-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
A 43-year-old asymptomatic patient was diagnosed with an azygos vein aneurysm on contrast-enhanced computed tomography; at the 5-year follow-up, contrast-enhanced computed tomography revealed development of an azygos vein aneurysm. However, preoperative contrast-enhanced computed tomography at our hospital showed thrombus development along with shrinkage of the azygos vein aneurysm. To prevent thrombus dissemination, we decided to perform surgery. The aneurysm was excised via video-assisted thoracoscopic surgery, and the patient recovered uneventfully. Thoracoscopic surgery is effective in managing azygos vein aneurysms and preventing embolisms in thrombotic aneurysms. This procedure was chosen to avoid excessive compression of aneurysms and to prevent pulmonary embolism. This report presents a case of surgical management of an idiopathic azygos vein aneurysm with thrombosis.Clinical registration number 2020-S-20.
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Wang ZX, Yang LL, Xu ZN, Lv PY, Wang Y. Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report. World J Clin Cases 2021; 9:2655-2661. [PMID: 33889633 PMCID: PMC8040170 DOI: 10.12998/wjcc.v9.i11.2655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/03/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Azygos vein aneurysms are extremely rare, and their pathogenesis is not clear. The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance. There are few reports on the diagnosis of and treatment strategy for this disease. Moreover, the choice of therapeutic schedule and the treatment window are controversial.
CASE SUMMARY We report a case of azygos vein arch aneurysm in a 53-year-old woman. The patient had symptoms of back pain, chest tightness, and choking. Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum, which was connected to the superior vena cava. The enhancement degree in the venous phase was the same as that of the superior vena cava. The patient received video-assisted thoracoscopic surgery. After the operation, her back pain disappeared, and her dysphagia and chest tightness were also significantly relieved. The postoperative pathology confirmed hemangioma. The patient was discharged on the seventh day after surgery without any comp-lications.
CONCLUSION Some patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea. Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms. In addition, despite the difficulty and risk of surgery, thoracoscopic surgery for azygos vein aneurysms is completely feasible.
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Affiliation(s)
- Zhen-Xing Wang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Liang-Liang Yang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Zhe-Nan Xu
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Pei-Yun Lv
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yue Wang
- Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Hatachi G, Miyazaki T, Obata T, Kitamura Y, Matsumoto K, Tsuchiya T, Yamasaki N, Kinoshita N, Nagayasu T. Successful resection to treat idiopathic azygos vein aneurysm. Asian J Endosc Surg 2018; 11:392-394. [PMID: 29322658 DOI: 10.1111/ases.12457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
Azygos vein aneurysm is a rare disease. Surgical resection is usually performed when it ruptures. To avoid the thromboembolism, procedures that do not touch or push the aneurysm are recommended. Herein, we report a case of idiopathic azygos vein aneurysm. A 56-year-old woman was admitted to the hospital for right lateral chest pain. Chest enhanced multi-detector CT revealed an azygos vein aneurysm in the posterior mediastinal space. No thrombus in the aneurysm was detected before surgery. Video-assisted thoracic surgery was performed to treat the aneurysm. The patient was discharged from the hospital 4 days after surgery. Video-assisted thoracic surgery was a good option to treat an azygos vein aneurysm, and an enhanced multi-detector CT was useful for performing surgery safely.
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Affiliation(s)
- Go Hatachi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Tomohiro Obata
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Yuka Kitamura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Naoya Yamasaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Naoe Kinoshita
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
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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 2013; 18:135-6. [PMID: 24092467 DOI: 10.1093/icvts/ivt436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Azygos vein aneurysm is very rare and most cases are detected incidentally. We report a safe resection of azygos vein aneurysm by video-assisted thoracoscopic surgery (VATS) under preoperative evaluation of thrombus by multidetector computed tomography (MDCT). A 60-year old woman presented to our department due to a mediastinal mass revealed by enhanced CT. A dynamic enhanced-CT scan showed a dilated azygos vein with great enhancement in the early phase. Under the diagnosis of azygos vein aneurysm, we analysed the aneurysm by MDCT and confirmed that there was no thrombus within the aneurysm. The resection of the aneurysm by VATS was performed safely. She was discharged 4 days after surgery.
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Affiliation(s)
- Yuichiro Ueda
- Department of Thoracic Surgery, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
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Choo JY, Lee KY, Oh SJ, Je BK, Lee SH, Kim BH. Azygos vein aneurysm mimicking paratracheal mass: dynamic magnetic resonance imaging findings. Balkan Med J 2013; 30:111-5. [PMID: 25207080 DOI: 10.5152/balkanmedj.2012.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/28/2012] [Indexed: 11/22/2022] Open
Abstract
Aneurysms of the azygos vein are rare and can sometimes mimic a paratracheal or posterior mediastinal mass. It is important to confirm the diagnosis with radiologic tools before performing invasive procedures, which carry the risk of hemorrhage. Here, we present a case in a 79-year-old asymptomatic patient of an increasing azygos vein aneurysm that mimicked a growing paratracheal mass. Review of images obtained using various modalities, including dynamic magnetic resonance image (MRI), revealed that the image findings were suggestive of azygos vein aneurysm. Using this method, an exact diagnosis can be reached without resorting to invasive procedures.
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Affiliation(s)
- Ji Yung Choo
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seon Jeong Oh
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Bo-Kyung Je
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
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