Azygos Vein Enlargement Secondary to Superior Vena Cava Syndrome on 18F-FDG PET/CT
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Obstruction of the blood flow from the superior vena cava (SVC) to the right atrium causes the SVC syndrome. The azygos system is the most important way to overcome SVC obstruction. Azygos vein enlargement can be seen secondary to the SVC syndrome. Although a few cases showing 18 F-FDG uptake along the SVC in SVC syndrome were reported before, 18 F-FDG PET/CT findings of azygos vein enlargement have not been documented yet. Herein, we presented an intriguing case of azygos vein enlargement secondary to SVC syndrome on 18 F-FDG PET/CT.Keywords:
Azygos vein
Azygos vein
Vena cava
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A 14-year-old male patient presented with swelling on his face and distension in the neck and chest vessels. Transvenous permanent pacemaker had been implanted because of sick sinus syndrome 3 years ago. There was oedema in the head-neck, he had jugular venous distension and varicose enlargement in the superficial veins of …
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Objective: To evaluate the safety and efficacy of unilateral covered stent placement in patients with malignant superior vena cava (SVC) syndrome.Materials and Methods: Between October 2008 and November 2012, expanded polytetrafluoroethylene-covered stent placement for malignant SVC syndrome was performed in 40 consecutive patients (35 men and five women; mean age, 61.4 years; range, 35-81 years).All covered stents were unilaterally placed within the SVC or across the venous confluence when needed to relieve venous obstruction and prevent tumor overgrowth, regardless of patency of contralateral brachiocephalic veins.Results: Stent placement was technically successful in all patients.There were no major complications.Of the 37 patients symptomatic prior to stent placement, 34 (92%) experienced complete symptomatic relief 1-8 days after stent placement.Of the 29 patients who underwent covered stent placement across the venous confluence, nine patients had patent contralateral brachiocephalic veins prior to stent placement.However, no sign of SVC obstruction or contralateral upper extremity venous thrombosis was observed during the follow-up period.Kaplan-Meier analysis revealed median patient survival of 163 days.Stent occlusion occurred in four (10%) of 40 patents.Cumulative stent patency rates at 1, 3, 6, and 12 months were 95%, 92%, 86%, and 86%, respectively.Conclusion: Unilateral covered stent placement appears to be a safe and effective method for treating malignant SVC syndrome, despite the location of SVC occlusion.
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Abstract Background Azygos vein aneurysm (AVA) is a rare thoracic pathological entity that mimics a posterior mediastinal mass. However, the pathogenesis of primary azygos vein aneurysms is not clear and its pathology is still being discussed. Some of the AVA are asymptomatic and usually discovered accidentally by routine physical examination. Case presentation We report the case of a 37-year-old woman who had an azygos vein arch aneurysm with no obvious clinical symptoms. With the analysis of clinical features of the case and AVA morphological characteristics, the AVA was found by a chest computed tomography. Then, enhanced chest computed tomography showed a soft-tissue mass (4.9 × 3.7 × 3.2 cm) in the right posterior mediastinum, which was connected to the superior vena cava and significantly enhanced with contrast agent stratification. The density of the tumor in the delayed stage was the same as that in the azygos vein. The patient underwent video-assisted thoracoscopic surgery. Histopathological evaluation of the surgical biopsy specimen proved to be a completely thrombosed aneurism of the azygos vein arch. Conclusions AVA is a rare pathology that must be taken into consideration during the differential diagnosis of right posterior mediastinal masses. Thoracoscopic surgery is one of the most preferred treatment options for azygos vein aneurysm.
Azygos vein
Cardiothoracic surgery
Mediastinal mass
Mediastinal tumor
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상대정맥 증후군의 비악성 원인은 염증, 특발성 종격동 섬유화, 대동맥류, 방사선 치료에 의한 섬유화 등이 주를 이루었으나, 최근에는 카테터의 장기간 거치 혹은 인공 심박동기, 제세동기 등에 의한 의인성 상대정맥 증후군이 증가추세에 있다. 상대정맥 증후군의 치료는 일반적으로 방사선치료와 항암치료 등이 알려져 있으나, 비악성 원인에 의한 경우는 스텐트 삽입을 통한 치료가 최근 대두되고 있다. 본 증례에서는 안면 부종, 양측 상지 부종으로 내원한 환자에서 혈관 조영술을 통하여 상대정맥 증후군을 확인하였고, 자기공명영상과 전산화 단층 촬영에서는 원인이 될 만한 특이소견이 없어 비악성 상대정맥 증후군으로 진단하였다. 환자는 스텐트 삽입술을 통하여 성공적으로 상대정맥 증후군을 치료받았으나, 스텐트 삽입 직후 드문 합병증인 폐부종을 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.
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Collateral circulation
Venography
Azygos vein
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Objective To evaluate CT findings of mediastinal venous abnormalities on enhanced chest CT.Methods The data of thirty-four patients with mediastinal venous abnormalities (MVAs) were peformed routine enhanced chest CT scan and retrospective reconstruction consequently which including volume rendering (VR) and curved multiplanar reconstruction (CPR).Results Of all the cases, 16 cases had left superior vena cava, 14 cases had abnormal connection between left brachiocephalic vein and azygos vein system, 2 cases had pulmonary varix, one had an azygos venoma, and the other had partial anomalous pulmonary vein drainage of the left upper lobe. VR displayed the abnomalities well, and CPR is complementary to curved plane.Conclusion The combination of routine enhanced chest CT scan and VR could reveal the MVAs. The right recognition of MVAs would be significant to some extent.
Azygos vein
Brachiocephalic vein
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Azygos vein
Thorax (insect anatomy)
Vascular anomaly
Vena cava
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Obstruction of the blood flow from the superior vena cava (SVC) to the right atrium causes the SVC syndrome. The azygos system is the most important way to overcome SVC obstruction. Azygos vein enlargement can be seen secondary to the SVC syndrome. Although a few cases showing 18 F-FDG uptake along the SVC in SVC syndrome were reported before, 18 F-FDG PET/CT findings of azygos vein enlargement have not been documented yet. Herein, we presented an intriguing case of azygos vein enlargement secondary to SVC syndrome on 18 F-FDG PET/CT.
Azygos vein
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Superior vena cava syndrome has various aetiologies but in the majority of cases it is caused by a malignant mass. Assessment of the underlying pathology as rapidly and reliably as possible is very important for proper therapy management. Dynamic computed tomography examination of the chest can differentiate patients in whom superior vena cava obstruction is caused by a mass, from those with a vascular aetiology. In patients with a mass, fine needle aspiration biopsy guided by the computed tomographic examination may provide cytological diagnosis in a fast and well tolerated manner.
Etiology
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