Azygous Vein Aneurysm (AVA): A Case Report

Abstract

A 70-year-old retired male physician presented to the Emergency Department with acute onset left sided chest pain for 1 day which started suddenly and progressively worsened. His symptoms evolved to include chest pain worsening with deep inspiration. He reported a history of hypertension and mild memory loss.Initial vital signs were, afebrile with a pulse of 77 beats per minute, respiratory rate of 18 breaths per minute, pulse oximeter 96% on room air, and blood pressure 138/91 mmHg. Pain score was 3/10.Examination findings revealed normal heart and lung auscultation and no pitting oedema. Thoracic imaging was suggested in the workup of presumed pulmonary embolism.Radiographs of the chest were performed showing widening of the paratracheal stripe [

Hemiazygos vein dilation as a radiological finding and multifactorial cause of dysphagia

“…Although complications such as mass effect have been described as a result of AVA/hemiazygos vein dilation, there is no universally accepted management strategy. For asymptomatic patients, a conservative or surveillance approach is utilized in the majority of cases [8 , 12] . For symptomatic patients, one approach encompasses the prevention of thromboembolism and rupture when an aneurysm is involved as well as the alleviation of symptoms [8] .…”

“…In this case, close observation and symptomatic relief with proton pump inhibitors was the initial choice. Surgical resection with or without venous bypass has also been performed, and yielded excellent results [8 , 12] . With the advent of endovascular approaches, stenting, venous occlusion, and embolization have been suggested as safe and effective ways to repair AVA/hemiazygos vein dilation [8] .…”

CT Findings of Azygos Venous System: Congenital Variants and Acquired Structural Changes

“…Although AVA are typically asymptomatic, they occasionally cause dyspnea, dysphagia, and chest discomfort or pain associated with mass effects or pulmonary thromboembolism ( 19 ). Both complete and partial thromboses of the AVA have been reported and may predispose patients to pulmonary embolism.…”

“…Both complete and partial thromboses of the AVA have been reported and may predispose patients to pulmonary embolism. Thrombus formation within the AVA has been hypothesized to result from sluggish flow and inflammation, which allow the intraluminal thrombus to flow into the pulmonary arteries ( 19 20 ).…”