Inomata Mayu, Kawano Fumiya, Yamada Ryusei, Maeda Ryo
Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Int J Surg Case Rep. 2024 Sep;122:110094. doi: 10.1016/j.ijscr.2024.110094. Epub 2024 Jul 30.
We present a case of idiopathic azygos vein aneurysm (AVA) and describe its radiological features. Clinicians should be aware of the imaging findings to avoid the risk of bleeding caused by biopsy.
An asymptomatic 46-year-old woman was found to have an abnormal shadow on a chest computed tomography (CT) scan during a medical checkup. Plain CT revealed a well-defined, homogeneous mass on the posterior side of the right main bronchus. Contrast-enhanced CT revealed a mass with marked enhancement pointing to a vascular structure. Three-dimensional reconstruction showed that the mass was connected to the azygos arch, and inflow to and outflow from the azygos vein was detected. Subsequently, video-assisted thoracic surgery was performed.
Patients with idiopathic AVA often present with accidental findings of a mediastinal or lung mass on a chest radiographs or CT scans, which can be mistakenly diagnosed as a paratracheal tumor, bronchial cyst, or posterior mediastinal tumor. Needle biopsy should be avoided due to the risk of massive bleeding. During the evaluation of thoracic malignancies, AVAs should be considered in the differential diagnosis, especially in area of the right tracheobronchial angle or right upper or posterior mediastinum. Three-dimensional reconstruction can help surgeons to clarify the disease diagnosis.
Imaging findings combined with enhanced CT and three-dimensional reconstruction are useful for diagnosing AVAs.
我们报告一例特发性奇静脉动脉瘤（AVA）病例，并描述其影像学特征。临床医生应了解这些影像学表现，以避免活检引起的出血风险。
一名46岁无症状女性在体检时胸部计算机断层扫描（CT）发现异常阴影。平扫CT显示右主支气管后侧有一个边界清晰、密度均匀的肿块。增强CT显示肿块有明显强化，提示为血管结构。三维重建显示肿块与奇静脉弓相连，并检测到奇静脉的血流进出情况。随后进行了电视辅助胸腔镜手术。
特发性AVA患者常在胸部X线片或CT扫描时偶然发现纵隔或肺部肿块，可能被误诊为气管旁肿瘤、支气管囊肿或后纵隔肿瘤。由于有大出血风险，应避免进行针吸活检。在评估胸部恶性肿瘤时，鉴别诊断应考虑AVA，尤其是在右气管支气管角或右上纵隔或后纵隔区域。三维重建有助于外科医生明确疾病诊断。
影像学表现结合增强CT和三维重建对诊断AVA很有用。
