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Pneumothorax with an azygos lobe

Case contributed by Francis Fortin
Diagnosis certain

Presentation

Fell from standing height.

Patient Data

Age: 75 years
Gender: Male

Cropped CT images

ct

The inferior portion of the azygos vein is hypoplastic, with a compensatory increase in size of the hemiazygos vein. A pneumothorax is seen extending under the fissure of an azygos lobe. Air is also seen outlining the azygoesophageal recess.

There is moderate hydropneumothorax with multiple rib fractures and subcutaneous emphysema.

Case Discussion

Despite azygos lobes occurring in up to 1% of people, reports of pneumothorax in patients with such variant anatomy are surprisingly rare 1-3. The pneumothorax here helps appreciate the anatomy of the azygos vein connecting with the superior vena cava, drawing down with it a thick double layer of pleura.

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