Thoracoscopic Azygos Vein Lobe Resection in a Patient with Synchronous Right and Left Lung Cancer.

Crohn’s disease, and anxiety underwent routine chest radiography due to a common cold infection, which surprisingly showed a large left upper lobe mass and a small paratracheal lesion in the right upper lobe. A computed tomography scan of the chest and a positron emission tomography-computed tomography (PET-CT) scan revealed only a 60 x 55 mm solid positive central left upper lobe mass and a 13 mm spiculated positive nodule in the azygos vein lobe (which was separated by the thin fissure from the rest of the right upper lobe) [Figure 1]. Transthoracic neet he azygos vein lobe, described by Wrisberg in 1877, is an anatomic variant due to an anomalous development of the right upper lobe and found in 0.1% to 8% of the population. Since the original description of carcinoma of the azygos vein lobe in 1969 by Mullin et al. [1], only a few cases have been reported in the literature [2,3], and only one on pulmonary adenocarcinoma originating in the azygos lobe [4]. The presence of synchronous bilateral lung carcinoma is another rare condition. Optimal treatment of synchronous lung carcinomas remains controversial due to difficulties in determining whether multiple lesions represent synchronous lung cancer or metastases. We present, to our knowledge, the first case of a 63 year old man after coronary artery bypass surgery, with synchronous primary adenocarcinoma of the azygos vein lobe and primary squamous cell carcinoma of the left upper lobe successfully treated surgically by bilateral staged thoracoscopy and thoracotomy techniques.