Odedra Anand, Farrugia Mark, Babiker Zahir
Department of Infection and Immunity, Barts Health Trust, London, UK.
Radiology Department, Barts Health Trust, London, UK.
BMJ Case Rep. 2014 Dec 24;2014:bcr2014204299. doi: 10.1136/bcr-2014-204299.
A 59-year-old Indian woman presented to the respiratory clinic with chest pains, long-standing swallowing difficulties and a chest radiograph, which was reported as showing a shadow in the right paratracheal region. A CT scan was obtained and was reported as demonstrating a right-sided paratracheal lymph node and varicosities adjacent to the inferior vena cava. Histology from an endobronchial ultrasound-guided biopsy revealed a heavily blood-stained sample but showed no evidence of granulomas or malignancy. Subsequently, the images were reviewed, with the conclusion that they were actually of an engorged azygos vein compressing the oesophagus. MRI confirmed the absence of mediastinal lymphadenopathy and the presence of a prominent hemiazygos vein compressing the oesophagus. This case highlights the importance of including anatomical abnormalities in the differential diagnosis and reassessing patients when the history and investigations do not correlate.
一名59岁的印度女性因胸痛、长期吞咽困难前往呼吸科门诊就诊，胸部X光片报告显示右气管旁区域有阴影。进行了CT扫描，报告显示右侧气管旁淋巴结及下腔静脉旁静脉曲张。经支气管超声引导下活检的组织学检查显示样本有大量血迹，但未发现肉芽肿或恶性肿瘤的迹象。随后，对图像进行了复查，结论是实际上是扩张的奇静脉压迫食管。MRI证实无纵隔淋巴结肿大，存在一条明显的半奇静脉压迫食管。该病例强调了在鉴别诊断中纳入解剖异常以及当病史和检查结果不相关时对患者进行重新评估的重要性。
