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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.
Respiratory system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Azygos vein– Drains post. wall of trunk– Arches over R. lung root to drain into SVC– Receives hemiazygos v. at T8 level– Receives accessory hemiazygos v. at T7 level– Other tributaries: lower 8 intercostal veins, R. superior intercostal vein, mediastinal veins
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.
Monochorionic Twin Discordance for Horseshoe Lung and Tricuspid Atresia
Published in Fetal and Pediatric Pathology, 2022
Marina Sousa Gomes, José Monterroso, Otília Brandão, Carla Ramalho
Despite maceration due to 6 weeks of intra-uterine retention, the autopsy of the female fetus confirmed some anomalies previously seen by ultrasound and identified others. A complex heart malformation was confirmed: dextrorotation, partial anomalous systemic venous return (hypoplastic right superior vena cava, persistent left superior vena cava draining to the right atrium via the coronary sinus, inferior vena cava draining to the coronary sinus and azygos vein draining into left superior vena cava), hypoplastic right pulmonary vein draining into the left atrium, small right atrium and normal left atrium, atrial septal defect, tricuspid atresia, and right ventricle without inlet chamber with a small outlet chamber (Figure 2). The left main pulmonary artery emerges from this small chamber. The right pulmonary artery emerged from the left artery just before entering the lung hilum. The pulmonary artery and its bronchial relationship on the left were normal. There was a horseshoe lung with hypoplasia of the right lung (Figure 3). There was a unilateral right cleft lip and palate. A normal left kidney and a small right pelvic kidney were identified (Figure 4). The placental examination confirmed a monochorionic gestation, with a paraseptal insertion of the umbilical cord in the abnormal fetus and marginal insertion of the umbilical cord in the normal fetus. The karyotype of the abnormal fetus, obtained from an amniotic fluid sample, was 46, XX.
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.
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.