Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report

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.

Thoracoscopic approach to the resection of idiopathic azygos vein aneurysm: a case report

“…In fact, a large aneurysm that is filled with numerous coils or Amplatzer vascular plugs may produce worsening of the compressing symptoms by mass effect, and curvature of the AVA may increase the difficulty of stent placement [ 9 , 11 , 12 , 23 ]. Surgical resection is a common method that is proposed for cases of idiopathic AVA or symptomatic cases [ 2 , 8 , 13 – 15 ]. No postoperative recurrence has been reported so far.…”

“…If it is necessary to remove the aneurysm, video-assisted thoracic surgery may be a good option for surgical treatment. But it must be performed with extreme care in order to prevent intraoperative thrombus migration resulting in pulmonary thromboembolism and massive hemorrhage [ 2 , 13 – 15 ]. Although the patient had no clinical symptoms in the study, the idiopathic saccular AVA was relatively larger in diameter and the filling defect was apparently detected by enhanced multidetector CT.…”

“…The optimal treatment strategy for AVA remains uncertain. Current treatment options include conservative treatment [ 10 ], interventional treatment [ 11 , 12 ], and surgical treatment [ 13 , 14 ]. We report the case of a presentation of an idiopathic AVA, which was surgically resected by thoracoscopic approach.…”

Single-port thoracoscopic removal of an azygos vein aneurysm: A case report and literature review

“…Summarizing the previously reported cases, most of the patients were asymptomatic or had their AVA discovered incidentally on physical examination for other reasons. Among the common symptoms in patients, 13 patients had chest pain [9][10][11][12][14][15]17,19,23,34,43,47,59] , 10 patients had chest tightness and even dyspnea [2][3][16][17][18]20,22,44] , 4 patients had cough [2,6,42,52] , 3 patients had symptoms of dysphagia [16,42,58] , and 3 patients' AVAs were accidentally discovered in trauma [2,8] . Contrast-enhanced CT and magnetic resonance imaging (MRI) are the main noninvasive methods for the diagnosis of AVA.…”

“…There had been no reports of single-port thoracoscopic AVA resection until this one. It is easy to cause the aneurysm to rupture and hemorrhage due to the thin wall of AVAs [23,32] , and there are risks such as thrombus migration [17] . We can minimize these risks during thoracoscopic surgery.…”