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Systemic Veins of the Thorax.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
The azygos vein lies anterior to or just to the right of the vertebral bodies until it arches anteriorly over the right main bronchus to join the SVC. It is usually well seen on frontal chest radiographs or conventional tomograms in the right tracheo-bronchial angle, where it makes an oval or rounded shadow above the right main bronchus, unless it lies more laterally within the right upper lobe within an azygos fissure (see below). It often produces a slight indentation on the lower right aspect of the trachea, especially when dilated. Its diameter is variable, being smaller in inspiration, the erect position or during the Valsalva manoeuvre. On erect radiographs its diameter is between 0.6 and 1 cm., but it is larger in heart failure with pericardial disease, venous obstruction (SVC or IVC obstruction), portal hypertension, or in pregnancy (up to 1.5 cm.). In the recumbent position it is commonly 1 to 1.5 cm., but larger even up to 2 cm. with the above conditions. Its appearance also varies with the patterns of pleural reflection. Occasionally the azygos vein is aneurysmal.
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Polysplenia syndrome is a form of left isomerism and one of the heterotaxy syndromes. Patients with polysplenia have multiple small spleens, bilobed lungs, hyparterial bronchi, bilateral left atria, partial anomalous pulmonary venous return (APVR), a midline liver and absent gallbladder. The superior vena cava continues as the azygous or hemiazygous vein.
Anatomy of veins and lymphatics
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
The azygos vein is unpaired and usually passes up in the posterior mediastinum on the right side beside the vertebral column (Figure 2.7). It drains blood from the posterior thoracic and abdominal wall to the superior vena cava, and communicates with the vertebral venous plexuses.
Thoracic Lymph Duct Catheterization with a Venous Shunt in the Nonhuman Primate
Published in Journal of Investigative Surgery, 2022
Jon Ehrmann, Claudia Generaux, Sharon Ostergaard, Wendy Johnson, Anne Rose, Vince Mendenhall
For lymph to return and drain back to the systemic circulation, a shunt was used to access a venous blood vessel. The initial use of the jugular vein as the vessel for the shunt posed a few complications. First, the ability to access the medial portion of the neck in surgery while maintaining good exposure of the thoracotomy was less than ideal. Additionally, incisions at the neck line were prone to irritation due to collar or jacket use postoperatively and appeared to reduce the duration of patency of the catheter. Due to its proximity (immediately dorsal to the lymphatic duct) the azygous vein was selected as a better option for shunt placement. This refinement merged the procedures into only one incision and allowed both the lymphatic and venous catheters to exit the body at the same site. The azygous vein is a small vessel much like the lymphatic duct, thus the use of surgical loupes was necessary to visually identify the location of these vessels. Additionally, the intercostal collateral vessels drain into the azygous vein and are quite visible during the dissection. These collaterals will cause a significant amount of bleeding once an incision is made into the azygous, filling the cavity with blood quickly and making it almost impossible to visualize the catheterization location. Therefore, to avoid this situation, ligatures are placed in front of each collateral vessel and the catheter was inserted into the small portion of the azygous vein isolated in between them.
Pericardial Anatomy, Interventions and Therapeutics: A Contemporary Review
Published in Structural Heart, 2021
Reza Reyaldeen, Nicholas Chan, Saberio Lo Presti, Agostina Fava, Chris Anthony, E. Rene Rodriguez, Carmela D. Tan, Walid Saliba, Paul C Cremer, Allan L. Klein
The pericardium is normally supplied by small branches from the internal thoracic, pericardiophrenic, musculophrenic, inferior phrenic arteries, and the thoracic aorta. Veins from the pericardium enter the azygos system of veins in the internal thoracic and superior phrenic veins. Innervation of the pericardium arises from the vagus nerve and the sympathetic trunks (via which the pericardium can modulate cardiac complexes and coronary tone via secretion of prostaglandins,14) as well as the phrenic nerves, which have somatic afferent fibers that represent the source of somatic pain sensation from the parietal pericardium. For this reason, “pain” related to a pericardial pathology is often referred to the supraclavicular region of the shoulder or lateral neck area dermatomes for spinal cord segments C3–C5.
A rare case of hemodialysis-related portosystemic encephalopathy and review of the literature.
Published in Acta Clinica Belgica, 2020
Barbara Geerinckx, Rachel Hellemans, Amaryllis H. Van Craenenbroeck, Sven Francque, Liesbeth De Waele, Jeroen Kerstens, Pieter-Jan Van Gaal, Bart Bracke, Peter Michielsen, Thomas Vanwolleghem
One case of a Spanish patient who developed PSE after PD was also reported [5]. He developed hepatic encephalopathy 15 months after starting continuous ambulatory PD therapy. During work-up, a shunt between the left gastric and azygos veins was found. Despite transfer to hemodialysis treatment, episodes of encephalopathy remained. Only after surgical ligation of the gastric vein, symptoms disappeared. The authors speculated that increased intra-abdominal pressure and vasodilation caused by PD solutions in a patient with a spontaneous PSS resulted in ammonia-rich blood flow from the PV to the superior vena cava with resultant encephalopathy. The other five cases [3,4,6–8] all concern patients with occurrence of encephalopathy during hemodialysis. Two of them received definitive surgical ligation of the shunt and the other three received B-RTO, all with successful outcome.