[Transosseous vengram of intercostal veins, azygos vein and internal thoracic vein].
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Azygos venous flow can be measured by a thermodilution catheter in patients with cirrhosis. This is a useful technique since azygos flow is thought to reflect the superior portosystemic collateral flow in these patients. The authors report 3 cases in which mistaken internal mammary vein cannulation mimicked azygos vein cannulation in the supine fluoroscopic view. A lateral fluoroscopic view confirmed internal mammary cannulation. They suggest that if the azygos arch is unpronounced or flow measurements are unexpectedly low in patients with portal hypertension due to cirrhosis, a lateral view be performed to rule out internal mammary vein cannulation.
Massive systemic-to-hepatic venous collaterals developed in a 8-year-old boy with left isomerism and azygos connection of the inferior vena cava who had undergone total cavopulmonary shunt leaving the hepatic vein connected to the common atrium 5 years previously. A hepatic vein-to-azygos vein connection via an autologous pericardial roll successfully ameliorated cyanosis and physical activity. Hepatic vein-to-azygos vein connection is technically easy and is favorable in providing balanced distribution of hepatic venous blood to both lungs. We recommend this technique as an effective alternative to hepatic vein-to-pulmonary artery connection in patients developing collateral vessels after total cavopulmonary shunt.
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The azygos veins in thirty six cadavers (26 adult bodies, 10 human fetuses) were examined with special reference to the correlation with the midline of the vertebral column. The azygos veins were often observed to cross the middle of the ventral side of the vertebral column from right to left, and the occurrence of this crossing to the left is more frequent than that previously described--occurring in twenty two of the adult bodies. In three of the adult bodies, the vein ran upwards along the midline. In the remaining adult, the azygos vein ascended on the right side only of the vertebral column. In the fetuses, no azygos vein crossed the midline and the vein lay only on the right side or along the midline of the vertebral column. these results indicate the possibility of leftward displacement of the azygos vein during the aging process.
We report the case of a living-donor lobar lung transplantation in which we found an abnormal segmental vein in the right lower lobe of the donor lung. The abnormal vein was anastomosed to the azygos vein of the recipient so that lung edema and congestion could be avoided. This alternative technique is effective in living-donor lobar lung transplantation when the superior segmental vein in the right lower lobe of the donor drains into the superior vein.
The continuation of the azygos vein with the inferior vena cava and a well demarcated azygos lobe of the right lung were detected during routine dissection of a 65-years-old white male cadaver. The azygos arch was found dilated and malpositioned to create an aberrant azygos fissure in the right superior lobe which, was occupied by a fold of parietal pleura. The developmental and clinical significance of the azygos lobe is discussed.
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The azygos vein of the rat can be divided into three regions: The proximal cardiac region, where the wall is composed of two and sometimes three layers of cardiac muscle and a thin discontinuous layer of smooth muscle cells. Vascular casts of this region demonstrate layers of capillaries closely following the orientation of the cardiac fibres. A transitional zone, where both cardiac and smooth muscle cells interdigitate. In this zone, close associations between smooth muscle and cardiac muscle cells can be observed, however, gap junctions do not appear to be present. Beyond this transitional zone the vessel resembles a typical thin-walled vein. The cells of the media of the entire length of azygous vein have been isolated and grown in culture and two separate viable populations identified corresponding to smooth and cardiac muscle.
Six children are reported in whom a central venous catheter from the internal jugular or the subclavian vein migrated to an anomalous position: the left superior intercostal vein in the first two cases, the thymic vein in the third, and the azygos vein in the last three. Resultant complications in five cases were: extravasation of the infusate in the first and third case; local vascular stenosis or complete vascular occlusion in the second and fifth case; and obstruction of the azygos arch due to local thrombosis and possible stenosis, with a likely extravasation of the infusate, in the sixth case. The mediastinal vascular anatomy related to these central venous catheters is reviewed with reference to similar and related cases in the literature.
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Increased intraspinal venous pressure, resulting according to ABOULKER in numerous spastic paraplegias and quadriplegias is due to multiple venous abnormalities demonstrated by cavo-spinal phlebography. The most frequent are stenoses of the internal jugular veins, the left renal, the left iliac veins, the azygos veins and compressions of the innominate venous trunks. These abnormalities cause a permanent stasis in the intraspinal plexuses through excessive supply or insufficient drainage. Out of 80 patients, 60 per cent had at least 2 abnormalities, 38 per cent at least 3 abnormalities.
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Idiopathic saccular aneurysm of the azygos vein is a rare condition. We report the case of a 52-year-old man with saccular aneurysm of the azygos vein who underwent surgical resection. Preoperative dynamic computed tomography revealed strong and rapid enhancement of the chest mass. Magnetic resonance imaging showed a thoracic tumor with low signal intensity on the T1-weighted image and coexistence of low and high signal intensity on the T2-weighted image. Intraoperative findings showed cystic dilatation of the azygos vein. Although an accurate preoperative diagnosis of saccular azygos vein aneurysm is difficult, especially differential diagnosis between this anomaly and mediastinal tumors, a markedly enhanced mass shown by dynamic computed tomography was useful for the preoperative diagnosis of this anomaly.
Primary anomalies of the azygos vein generally result from intrathoracic tumor compression or inferior vena caval interruption with azygos vein continuation. Vascular malformations, although uncommon, can frequently mimic solid tumors and present as middle or posterior mediastinal masses. We present the case of an isolated giant azygos vein varix in an asymptomatic patient. Preoperative computed tomography and magnetic resonance imaging were not diagnostic in evaluating this patient's anatomy.