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Vol. 54. Num. 4.April 2018
Pages 175-240
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Vol. 54. Num. 4.April 2018
Pages 175-240
Clinical image
DOI: 10.1016/j.arbres.2017.07.017
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Unexpected Intraoperative Finding of Azygos Vein Aneurysm Mimicking a Metastatic Lymph Node
Hallazgo intraoperatorio inesperado de un aneurisma de la vena ácigos en forma de nódulo linfático metastásico
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Andrés Obeso
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andresobca@hotmail.com

Corresponding author.
, Redha Souilamas
Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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A 74-year-old female with a 15mm spiculated nodule who underwent VATS right upper lobectomy. An unsuspected paratracheal mass was identified intraoperatively below the arch of the azygos vein (Fig. 1A). Any abnormally enlarged lymph nodes had been reported in the computed tomography scan preoperatively. However, given the suspicion of N1 disease, biopsy was performed leading to rupture and bleeding of what turned out to be an aneurysm of the azygos vein. Bleeding was easily controlled by VATS. The patient was extubated and transfer to the ICU. Postoperative course was uneventful and the patient was discharge in the 4th postoperative day. Pathological analysis was consistent with a moderately differentiated squamous cell carcinoma pT1aN0M0. Postoperative review of the images confirmed the presence of a saccular aneurysm (19mm×11mm) in the proximal end of the arch of the azygos vein (Fig. 1B).

Fig. 1.
(0.17MB).

(A) Videothoracoscopic image of the aneurysm of the Azygos vein. (B) Axial contrast-enhanced CT scan. Postoperative review of the images confirmed the presence of a saccular aneurysm (white arrow) in the proximal end of the arch of the azygos vein.

Aneurysms of the azygos vein are very infrequent vascular malformations. Patients are usually asymptomatic, although complications such as thrombosis, rupture or compression of adjacent organs have been described.1 Small and saccular aneurysm of the azygos vein can simulate a pathological lymph node,2 especially in the context of oncological surgery, and preoperative identification can be challenging.

References
[1]
C. Kurihara, M. Kiyoshima, Y. Asato, H. Suzuki, M. Kitahara, M. Satou
Resection of an azygos vein aneurysm that formed a thrombus during a 6-year follow-up period
Ann Thorac Surg, 94 (2012), pp. 1008-1010 http://dx.doi.org/10.1016/j.athoracsur.2012.01.086
[2]
Y. Sato, K. Murata, A. Wada, M. Takamori
Azygos vein aneurysm mimicking a calcified lymph node
Copyright © 2017. SEPAR
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Archivos de Bronconeumología (English Edition)

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