Azygos Vein Varix Mimicking Mediastinal Mass in a Patient With Liver Cirrhosis

Lee, Shih-Yi; Kuo, Hsu-Tah; Peng, Ming-Jen; Lin, Fung-J; Shih, Shou-Chuan; Sheu, Chin-Yin; Lin, Ching-Chi

doi:10.1378/chest.127.2.661

Cited by 19 publications

(12 citation statements)

References 4 publications

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“…Aneurysm may also be caused by developmental interruption of the intrahepatic inferior vena cava (IVC) (3). When an aneurysm of the azygos vein does not fit any of these causes, as in our case, it is assumed to be congenital (4).…”

Section: Discussionmentioning

confidence: 72%

“…During the fifth week, several other veins develop, including the supracardinal veins, which afterwards become the azygos vein. The arch of the azygos vein is formed by the persisting part of the posterior cardinal vein, which is joined by 112 Anatomically, this confluence can be a critical point that facilitates the development of an aneurysm (4). That is, a remnant of either the right posterior cardinal vein, subcardinal vein, or primitive subclavian veins, which empties into the transverse part of the azygos vein, may be the origin of a saccular aneurysm ( Figure 4) (2).…”

Section: Discussionmentioning

confidence: 99%

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Azygos Vein Aneurysm Mimicking Paratracheal Mass: Dynamic Magnetic Resonance Imaging Findings

Choo¹,

Lee²,

Oh³

et al. 2013

Balkan Med J

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Azygos Vein Aneurysm Mimicking Paratracheal Mass: Dynamic Magnetic Resonance Imaging Findings

Choo¹,

Lee²,

Oh³

et al. 2013

Balkan Med J

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“…A giant varix of the azygous vein is a rare cause of a mediastinal mass. [10] This finding should raise suspicion for superior vena cava flow obstruction, severe pulmonary hypertension or hypervascular tumor draining into the azygous system, or as in this case chronic BCS [10]. This finding underscores the importance of recognition of a giant azygous varix as an underlying cause of a mediastinal mass in patients with vena caval obstruction since a biopsy of this mass could prove fatal.…”

Section: Discussionmentioning

confidence: 84%

Budd-Chiari syndrome, mediastinal mass and recalcitrant leg ulcers, an unlikely trio

Tafur

Wysokiński

Vrtiska

et al. 2009

J Thromb Thrombolysis

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A 59 year old non-smoker male presented with a long history of recalcitrant lower extremity ulcers. Forty years ago, he underwent splenectomy for a nonmalignant reason. Shortly after his surgery, he developed multiple collateral veins over his abdomen with extensive lower extremities venous varicosities. He was ultimately diagnosed with Budd-Chiari syndrome (BCS), classified as Budd-Chiari type I whereby the thrombus was limited to the intrahepatic inferior vena cava, not directly compromising the hepatic veins [1,2]. He was initially treated with warfarin but due to bleeding complications, this medication was discontinued. More recently, he has been plagued with chronic recurrent lower extremity ulcers. Although healing promptly with compression therapy, his clinical course was marked by frequent ulcer recurrence. He otherwise denied dyspnea or recent weight changes.Physical examination revealed a 10 cm ulcer involving the medial foreleg of the right lower extremity with hemosiderin staining and dermal sclerosis. Multiple large varices were evident on the inspection of his extremities. There was no evidence of lower extremity deep vein thrombosis on venous Doppler ultrasound. His ECHO revealed a normal left ventricular ejection fraction (68%) and normal right ventricular systolic pressure. Laboratory evaluation was negative for lupus anticoagulant, factor V Leiden and PT 20210 mutation. He had normal levels of protein C and S and there was no evidence of myelodysplasia. His initial evaluation however, also included a chest X-ray that revealed a soft-tissue prominence in the right tracheobronchial angle (Fig. 1) worrisome for malignancy. DiagnosisThe presence of an indeterminate right paratracheal mass prompted CT of the chest and abdomen to exclude malignancy. We present his CT as a pictorial demonstration of several physiologic and imaging characteristics associated with BCS. The underlying pathology of BCS is represented by occlusive calcified thrombus within the intrahepatic IVC ( Fig. 2a; thick arrow). The intrahepatic IVC occlusion results in development of extensive collateral pathways including a markedly enlarged azygous system as well as prominent hemiazygous (HA) and intercostal collateral systems (thin arrows) [3][4][5]. The indeterminate soft tissue prominence noted on the plain film of the chest was shown to be due to the marked dilatation of the azygous system in the right tracheobronchial angle ( Fig. 2b; arrow). The correlative chest CT confirmed that there was no imaging findings of lymphadenopathy or neoplasm in the chest or abdomen and the chest X-ray findings were shown to be due to physiologic changes from BCS. DiscussionWith an estimated prevalence of nearly two per million inhabitants, Budd-Chiari syndrome (BCS) is a rare disease [6,7]. BCS may have a high degree of heterogeneity A. Tafur Á W. Wysokinski Á T. Vrtiska Á R. McBane II

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“…Although varicose veins can theoretically exist in every part of the human body, a solitary varicose vein is rare. Some reports have described mediastinal varicose veins, with most resulting from portal vein hypertension or vena caval obstruction [Lee 2005]. Mediastinal varicose vein without portal hypertension or vena caval obstruction is also extremely rare, and we were only able to find 1 case report in the literature [Pop 2005].…”

Section: Discussionmentioning

confidence: 84%

Cardiac Tamponade due to a Ruptured Solitary Mediastinal Varix: A Case Report

Kaneda¹,

Onoe²,

Moriwaki³

et al. 2007

The Heart Surgery Forum

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Mediastinal varix is rare. Some reports have noted that the mediastinal vein can become varicose in cases of portal hypertension or obstruction of the vena cava. However, solitary mediastinal varices without portal hypertension or obstruction of the vena cava are very rare. Mediastinal varicose veins have been problematic as pseudotumors, as no symptoms have been described in the literature. We encountered a case of cardiac tamponade due to a ruptured solitary mediastinal varicose vein. To the best of our knowledge, this is the first report of sustained symptomatic mediastinal varicose vein.

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Azygos Vein Varix Mimicking Mediastinal Mass in a Patient With Liver Cirrhosis

Cited by 19 publications

References 4 publications

Azygos Vein Aneurysm Mimicking Paratracheal Mass: Dynamic Magnetic Resonance Imaging Findings

Azygos Vein Aneurysm Mimicking Paratracheal Mass: Dynamic Magnetic Resonance Imaging Findings

Budd-Chiari syndrome, mediastinal mass and recalcitrant leg ulcers, an unlikely trio

Cardiac Tamponade due to a Ruptured Solitary Mediastinal Varix: A Case Report

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