• Journal of Trauma and Injury
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• v.36 no.1
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• pp.53-55
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• 2023

Azygos vein injuries are rare consequences of blunt trauma. When there is high drainage output from a right-sided intercostal catheter, an azygos injury must be considered in the differential diagnosis. We report the case of a 38-year-old male patient involved in a fall from a height during a motorcycle accident. Computed tomography demonstrated a large right-sided hemothorax and left-sided pneumothorax. The patient was transferred to the operating theatre and underwent a clamshell thoracotomy. A laceration in the azygos vein at the confluence of the arch of the azygos and the right superior intercostal vein was identified. Bleeding was controlled at the trifurcation. The patient survived and was discharged home on postoperative day 15.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.140-142
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• 2023

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.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1243-1246
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• 1998

Tracheobronchial injuries are uncommon. Except for the cervical region, most tracheobronchial injuries are due to blunt chest trauma in Korea. The depth of the tracheobronchial trees renders these structures relatively safe from stab wound. We experienced a case of left main bronchial laceration with azygos vein tear following stab wound in the back of right chest firstly in Korea. The patient was a 24 years old male. A routine chest radiography showed a knife in chest at emergency room. We didn't remove the knife at emergency room. This patient was carried to operation room in 30 minutes after arrival of our hospital without computed tomography and bronchoscopy. The operation was performed through standard right posterolateral thoracotomy and then the knife was removed. The left main bronchus and azyos vein were lacerated obliquely. The penetrated azygos vein was ligated and the laceration of the left main bronchus was repaired. Postoperative course was uneventful.

• Journal of Veterinary Clinics
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• v.35 no.3
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• pp.114-118
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• 2018

A 3-month-old intact male Lakeland terrier was presented with recurring regurgitation after removing cervical esophageal foreign body by endoscopy. Blood and urine analysis, radiography, ultrasonography, fluoroscopic esophagography, computed tomographic angiography (CTA) were performed. In radiography and fluoroscopic esophagography, vascular ring anomaly was considered as the primary cause of megaesophagus, and CTA with gas-inflation of the esophagus was performed. Compressed esophagus, persistent right aortic arch (PRAA), aberrant left subclavian artery (LSA), and a venous structure which was confirmed in surgery to be incomplete type persistent left cranial vena cava (PLCVC) connected with the left side azygos vein were observed. Left deviation of the trachea was also revealed in CT, which implies the compression by left ligamentum arteriosum. Therefore, type 3 PRAA with left ligamentum arteriosum and aberrant LSA, was considered as a prior differential diagnosis. Surgical repair was performed and the clinical signs improved. This report describes CTA characteristics of combination of PRAA with aberrant LSA, incomplete PLCVC and Lt. azygos vein in a dog. Although not every vascular anomaly does induce clinical sign, some types can complicate the surgical procedure, and cause clinical signs. Therefore, thorough evaluation of vascular anomalies in the thorax is important, and CTA is a useful method in identifying multiple vascular anomalies in dogs.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.95-108
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• 2024

The azygos venous system is a crucial conduit of the posterior thorax and potentially vital collateral pathway. However, it is often overlooked clinically and radiologically. This pictorial essay reviews the normal azygos venous anatomy and CT findings of congenital variations and structural changes associated with acquired pathologies.

• Tuberculosis and Respiratory Diseases
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• v.42 no.5
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• pp.787-792
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• 1995

The obstruction of inferior vena cava(IVC) is uncommon condition. The classification is based on the obstructive sites of major anatomic segments of IVC. The main collateral pathways of interruption of IVC were central channels through ascending lumbar veins, intervertebral veins and azygos-hemiazygos complex. However, the complete obstruction of mid-portion of IVC, accompanying collateral cirulation with pericardiacophrenic vein was rarely reported. We had experienced a case of complete obstruction of mid-portion of IVC with lobulated left cardiac border, which was unforgettable characteristic finding on chest radiograph. It was confirmed by venographic examination that the lobulated left cardiac shadow was a collateral circulation of pericardiacophrenic vein.

• Journal of Chest Surgery
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• v.48 no.4
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• pp.277-280
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• 2015

We report the case of a 37-year-old man who suffered from biventricular failure due to left isomerism, inferior vena cava interruption with azygos vein continuation, bilateral superior vena cava, double outlet of right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and isolated dextrocardia. Heart transplantation in patients with systemic venous anomalies often requires the correction and reconstruction of the upper & lower venous drainage. We present a case of heart transplantation in a patient with left isomerism, highlighting technical modifications to the procedure, including the unifocalization of the caval veins and reconstruction with patch augmentation.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.235-238
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• 1996

Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperhidrosis, especially when the upper limbs are affected. We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which made it easier to perform the explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure. On the 4th postoperative day, pulmonary edema and heart failure were cured; and the patient was extubated. But in the evening of the same day ST-segment elevation and Q-wave were noted on ECG monitoring. On the 13th postoperative day coronary angiography was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronary spasm, treated by vasodilator. On the 14 day, after surgery, he was discharged to return to work.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.698-706
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• 1990

Congenital Cystic Lung Disease is a spectrum of closed related anomalies that arise during an early stage of embryonic lung bud maturation-namely bronchogenic cyst, congenital lobar emphysema, pulmonary sequestration and congenital cystic adenomatoid malformation. And they show similar surgical strategies. So they are called as the term bronchopulmonary-foregut malformations, firstly proposed by Gerle[1968]. From Aug. 1979 to Aug 1989, 47 patients were operated upon on Dept. of Thoracic & Cardiovascular Surgery at the CUMC. There were 21 females and 26 males ranging in age from age of 21 day to age of 56 year [15 cases under 15 years old]. 30 patients had bronchogenic cysts - 23 of intrapulmonary type, 7 of mediastinal type in location. Affected lobes and locations were as follows: 11 in upper lobe, 3 in middle lobe, 11 in lower lobe and anterosuperior, middle, and posterior mediastinal type were 3, 2, 2 respectively. There were 9 pulmonary sequestrations[all intralobar type] with the distribution of 5 in right lower lobe and 4 in left lower lobe. And associated anomalies were presented with arterial supply originating from thoracic aorta[8 cases], abdominal aorta[1 case] and with venous drainage into azygos vein[1 case]. They all were operated upon lower lobectomy [8 case], pneumonectomy[1 case] in case of pulmonary hypoplasia Congenital lobar emphysema and congenital cystic adenomatoid malformation had 4 cases respectively. Their affected lobes were as follows: the former were 3 in upper lobes, 1 in middle lobe and the latter were 3 in upper lobe, 1 in lower lobe. They were treated with lobectomy and segmentectomy. Diagnosis was aided by chest X - ray, bronchography, aortography, DSA and CT scan, They all were confirmed by pathologic exams. There were no hospital death but few minor morbidities such as, atelectasis-pneumonia[2], wound infection[2], prolonged chest tube placement[2]. We experienced surgical treatments of 47 cases for 10 years and reported them with literature review.

• Tuberculosis and Respiratory Diseases
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• v.69 no.3
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• pp.184-190
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• 2010

Background: The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE). Methods: Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied. One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction. CT parameters were analyzed to determine their ability to predict a major adverse event (MAE). Results: There were 220 patients included and 61 (27.7%) had MAE. Left ventricular and right ventricular maximum minor axis ($36.4{\pm}8.0$ vs. $41.7{\pm}7.4$, p<0.01; $45.7{\pm}9.4$ vs. $41.5{\pm}7.6$, p<0.01), superior vena cava diameter ($19.2{\pm}3.4$ vs. $18.0{\pm}3.4$, p=0.02), azygos vein diameter ($10.0{\pm}2.2$ vs. $9.2{\pm}2.3$, p=0.02), septal displacement (19 vs. 18, p<0.01) were significantly higher in MAE group than in no MAE group. Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE ($1.34{\pm}0.48$ vs. $1.03{\pm}0.28$, p<0.01). The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62~0.79). Conclusion: RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.