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

Abstract

Background Azygos vein aneurysm (AVA) is a rare thoracic pathological entity that mimics a posterior mediastinal mass. However, the pathogenesis of primary azygos vein aneurysms is not clear and its pathology is still being discussed. Some of the AVA are asymptomatic and usually discovered accidentally by routine physical examination. Case presentation We report the case of a 37-year-old woman who had an azygos vein arch aneurysm with no obvious clinical symptoms. With the analysis of clinical features of the case and AVA morphological characteristics, the AVA was found by a chest computed tomography. Then, enhanced chest computed tomography showed a soft-tissue mass (4.9 × 3.7 × 3.2 cm) in the right posterior mediastinum, which was connected to the superior vena cava and significantly enhanced with contrast agent stratification. The density of the tumor in the delayed stage was the same as that in the azygos vein. The patient underwent video-assisted thoracoscopic surgery. Histopathological evaluation of the surgical biopsy specimen proved to be a completely thrombosed aneurism of the azygos vein arch. Conclusions AVA is a rare pathology that must be taken into consideration during the differential diagnosis of right posterior mediastinal masses. Thoracoscopic surgery is one of the most preferred treatment options for azygos vein aneurysm.

Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report

“…Mediastinal hemangioma is relatively benign, and therapies are still being debated. Moreover, there is a lack of guidelines or therapeutic flow charts that clearly define the indication for conservative, surgical, or endovascular treatment [ 6 ]. Therefore, we considered MDT mandatory, and the preoperative endovascular embolization procedure is a direct consequence of a multimodal approach.…”

“…The decision on surgical approach is also affected by improved safety of hemostasis of minimally invasive surgery. Indeed, video-thoracoscopic contributed to excellent postoperative outcomes and enhanced recovery [ 1 , 3 , 6 , 8 , 16 , 18 , 25 , 26 , 27 , 28 ]. Unnecessary intraoperative manipulation of the MHA should be avoided to prevent hemorrhagic complications [ 29 ].…”

“…Patients presenting with MHA are mainly asymptomatic, although clinical signs and symptoms may result from compression of nearby structures [ 5 ]. The optimal treatment strategy for MHA remains uncertain, though a multidisciplinary approach is suggested to prevent intraoperative complications and improve postoperative outcomes [ 6 ].…”

Azygos Vein Pseudoaneurysm After Trauma: A Case Report

“…Studies and clinical practice offer diverse perspectives without a universally accepted aneurysm size dictating surgery. Cases show successful non-surgical management regardless of size [11], yet larger AVPs pose risks of complications like rupture or thrombosis, warranting surgical consideration [12]. The necessity for surgery relies on multiple factors: a patient's symptoms, clinical condition, possible complications, and the expertise of the medical team.…”