Abstract
We present a primary spontaneous pneumothorax involving a possible diagnostic and surgical pitfall. A 25-year-old man with a previously identified azygos lobe was admitted to our hospital because of right primary spontaneous pneumothorax. A preoperative chest X-ray at the onset of the pneumothorax as well as after resolution by tube drainage showed an azygos fissure but no azygos vein. Chest computed tomography revealed the dislocated azygos vein external to the azygos fissure on the mediastinal side of the reexpanded upper lobe. Thoracoscopic bullectomies were uneventfully performed. The azygos arch was found dangling in the free inferior border of the mesoazygos. An azygos vein located in this position can be a potential surgical hazard especially in video-assisted thoracic surgery. This case suggests that the presence of an azygos lobe can be missed on chest X-ray when a pneumothorax occurs in a patient with an azygos lobe.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sedrakyan A, van der Meulen J, Lewsey J, Treasure T. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: Systematic review of randomized clinical trials. BMJ 2004; 329: 1008.
Margolis M, Gharagozloo F, Tempesta B, Trachiotis GD, Katz NM, Alexander EP. Video-assisted thoracic surgical treatment of initial spontaneous pneumothorax in young patients. Ann Thorac Surg 2003; 76: 1661–4.
Felson B. The azygos lobe: Its variation in health and disease. Semin Roentgenol 1989; 24: 56–66.
Caceres J, Mata JM, Andreu J. The azygos lobe: Normal variants that may simulate disease. Eur J Radiol 1998; 27: 15–20.
Boyden EA. The distribution of bronchi in gross anomalies of the right upper lobe, particularly lobes subdivided by the azygos vein and those containing pre-eparterial bronchi. Radiology 1952; 58: 797–807.
Sieunarine K, May J, White GH, Harris JP. Anomalous azygos vein: A potential danger during endoscopic thoracic sympathectomy. Aust N Z J Surg 1997; 67: 578–9.
Smith J, Karthik S, Thorpe JA. Pulmonary azygous lobe: A potential obstacle during thoracoscopic sympathectomy. Eur J Cardiothorac Surg 2004; 25: 137.
Weissman JL, Austin JH. Pneumothorax and an azygos lobe. J Thorac Imaging 1989; 4: vi-ix.
Sadikot RT, Cowen ME, Arnold AG. Spontaneous pneumothorax in a patient with an azygos lobe. Thorax 1997; 52: 579–80.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Asai, K., Urabe, N. & Takeichi, H. Spontaneous pneumothorax and a coexistent azygos lobe. Jpn J Thorac Caridovasc Surg 53, 604–606 (2005). https://doi.org/10.1007/s11748-005-0147-y
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11748-005-0147-y