DOI QR코드

DOI QR Code

Migratory Azygos Lobe: A Case Report

  • Min Suk Choi (Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Eung-Joong Kim (Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine)
  • Received : 2022.08.23
  • Accepted : 2022.10.16
  • Published : 2023.03.05

Abstract

The azygos vein sometimes merges abnormally across the right upper lobe of the lung and it hangs at the lower edge of a membranous septum, called the meso-azygos. The septum invaginates the lobe and makes a fissure. The smaller medial part of the right upper lobe is called an azygos lobe. A 16-year-old male patient was diagnosed with right-sided pneumothorax, and a closed thoracostomy was done in the emergency room. During elective wedge resection including the bulla, the meso-azygos, abnormal azygos vein, and azygos lobe were detected. We reviewed the computed tomography images and found that the azygos lobe had re-expanded laterally, not medially, to the meso-azygos after the closed thoracostomy in the emergency room. The patient had been diagnosed with left-sided pneumothorax a year ago, and no one noticed the azygos lobe at that time. We report the intraoperative findings and comparative images of a migratory azygos lobe.

Keywords

References

  1. Stibbe EP. The accessory pulmonary lobe of the vena azygos. J Anat 1919;53(Pt 4):305-14. 
  2. Hirose S, Cowles RA. Images in clinical medicine: azygous lobe. N Engl J Med 2007;356:2082. https://doi.org/10.1056/NEJMicm061526 
  3. Cairney J. The lobe of the azygos vein: note on two additional cases. J Anat 1923;58(Pt 1):54-8. 
  4. Internullo E, Migliore M. Pneumothorax and mediastinal emphysema due to an air leak from a bulla in an azygos lobe. Eur J Cardiothorac Surg 2005;28:641. https://doi.org/10.1016/j.ejcts.2005.06.045 
  5. Nakata S, Satake S, Okumura Y, Hara S, Min K, Nakayama K. Primary spontaneous pneumothorax with an azygos lobe. Kyobu Geka 2016;69:1017-9. 
  6. Asai K, Urabe N, Takeichi H. Spontaneous pneumothorax and a coexistent azygos lobe. Jpn J Thorac Cardiovasc Surg 2005;53:604-6. https://doi.org/10.1007/s11748-005-0147-y 
  7. Sadikot RT, Cowen ME, Arnold AG. Spontaneous pneumothorax in a patient with an azygos lobe. Thorax 1997;52:579-80. https://doi.org/10.1136/thx.52.6.579 
  8. Takasugi JE, Godwin JD. Left azygos lobe. Radiology 1989;171:133-4. https://doi.org/10.1148/radiology.171.1.2928516 
  9. Sieunarine K, May J, White GH, Harris JP. Anomalous azygos vein: a potential danger during endoscopic thoracic sympathectomy. Aust N Z J Surg 1997;67:578-9. https://doi.org/10.1111/j.1445-2197.1997.tb02046.x 
  10. Gill AJ, Cavanagh SP, Gough MJ. The azygos lobe: an anatomical variant encountered during thoracoscopic sympathectomy. Eur J Vasc Endovasc Surg 2004;28:223-4. https://doi.org/10.1016/j.ejvs.2004.02.011