BACKGROUND/AIMS: Differentiation of an extraluminal compression from a true subepithelial tumor (SET) in the esophagus by using endoscopy alone is often difficult. EUS is known as the best method for differentiating an extraluminal compression from a true SET. Extraluminal compression in the esophagus is occasionally observed, but its clinical significance has been rarely reported. Therefore, we aimed to evaluate the clinical significance of extraluminal compression in the esophagus according to the location of the lesion. MATERIALS AND METHODS: Sixty-one patients were diagnosed as having an extraluminal compression in the esophagus by using EUS between January 2006 and March 2014. Some patients underwent chest computed tomography for accurate diagnosis. RESULTS: The extraluminal compression was located at the mid-esophagus in 26 cases, lower esophagus in 22 cases, and upper esophagus in 13 cases. Of the 61 cases, 55 were caused by normal structures and 6 were caused by pathological lesions. The causes of the normal structures were the aorta, vertebra, trachea, left main bronchus, azygos vein, and diaphragm. The causes of the pathological lesions were engorged vessels and calcified lymph nodes. The posterior wall was the most frequent location of the extraluminal compression. However, the lesions in the anterior and right walls showed a higher frequency of pathological lesions than those in other sites. CONCLUSIONS: If the extraluminal compression is found in the anterior and right walls of the esophagus, more careful evaluation should be performed considering the high frequency of pathological lesions in the site.
Aorta ; Azygos Vein ; Bronchi ; Diagnosis ; Diaphragm ; Endoscopy ; Endosonography ; Esophagus* ; Humans ; Lymph Nodes ; Methods ; Spine ; Thorax ; Trachea

A 73-year-old female with diabetes admitted for treatment of an intertrochanter fracture of the femur and a urinary tract infection (UTI) with Escherichia coli developed thrombosis in her right azygos vein, which was thought to be associated with antiphospholipid and immunoglobulin M anticardiolipin antibodies. After antibiotic therapy, antiphospholipid antibody was undetectable, and a repeat chest computed tomography showed complete resolution of the azygos vein thrombosis. A wide variety of infections can be associated with thrombotic events in patients with transient antiphospholipid syndrome (APS), and this case serves as a reminder that the possibility of transient APS should be considered in patients with venous thrombosis in the setting of a UTI.
Aged ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Azygos Vein* ; Escherichia coli* ; Escherichia* ; Female ; Femur ; Humans ; Immunoglobulin M ; Thorax ; Thrombosis ; Urinary Tract Infections* ; Urinary Tract* ; Venous Thrombosis

Azygos vein aneurysm is a rare cause of mediastinal mass. Most cases present as an incidental finding on imaging modalities, but in few cases the thrombosis in the aneurysm leads to pulmonary thromboembolism, which may require surgical resection. We present a case where, for the first time, a case of a complicated azygos vein aneurysm was diagnosed in infancy, which required surgical resection.
Aneurysm* ; Azygos Vein* ; Humans ; Incidental Findings ; Infant* ; Mediastinal Diseases ; Pulmonary Embolism* ; Thrombosis

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein* ; Catheters* ; Extracorporeal Membrane Oxygenation* ; Heart ; Hernias, Diaphragmatic, Congenital* ; Humans ; Infant, Newborn* ; Oxygen ; Radiography, Thoracic

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein ; Catheters ; Extracorporeal Membrane Oxygenation ; Heart ; Hernias, Diaphragmatic, Congenital ; Humans ; Infant, Newborn ; Oxygen ; Radiography, Thoracic

We report the case of a 37-year-old man who suffered from biventricular failure due to left isomerism, inferior vena cava interruption with azygos vein continuation, bilateral superior vena cava, double outlet of right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and isolated dextrocardia. Heart transplantation in patients with systemic venous anomalies often requires the correction and reconstruction of the upper & lower venous drainage. We present a case of heart transplantation in a patient with left isomerism, highlighting technical modifications to the procedure, including the unifocalization of the caval veins and reconstruction with patch augmentation.
Adult ; Azygos Vein ; Dextrocardia ; Drainage ; Heart Defects, Congenital ; Heart Transplantation* ; Heart Ventricles ; Heart* ; Humans ; Isomerism* ; Pulmonary Valve Stenosis ; Veins ; Vena Cava, Inferior ; Vena Cava, Superior

BACKGROUNDSeveral studies, including those done in China, report that paravertebral vascular injury during posterior spinal surgery can greatly harm patients, though it is a relatively rare complication. However, few studies have examined their course and anatomic relationship to the spine. The aim of this study was to measure the course of the major paravertebral vessels and their positional relationships to the vertebral bodies in Chinese subjects using computed tomography.

METHODSWe studied a total of fifty subjects who underwent thoracolumbar computed tomography from T1-S1 at our institution. We measured the theoretical distance, actual distance, theoretical angle, and actual angle of the paravertebral vessels at each thoracolumbar intervertebral disc.

RESULTSThe paravertebral artery actual angle at T4-L4 ranged from -11.41 to 79.75° and the actual distance from 16.98 to 52.53 mm. The actual angle of the inferior vena cava at L1-L5 intervertebral disc ranged from -40.75 to 34.50° and the actual distance from -36.63 to 61.69 mm. There was no significant difference in the actual angle of the paravertebral vein or in the actual distance in the thoracic segments according to gender (P > 0.05). However, the actual distance in the lumbar segments were significantly different according to gender (P < 0.05).

CONCLUSIONSThe major paravertebral vessels' course is closer to the mid-sagittal plane as they move posterior along the vertebrae, and the actual distance of the paravertebral artery and azygos vein increase, while the actual distance of the inferior vena cava decreases. The course of the lumbar paravertebral vessels varies, especially at L4/L5, and may be more prone to intraoperative injury in female subjects.

Adolescent ; Adult ; Arteries ; injuries ; Azygos Vein ; diagnostic imaging ; injuries ; Female ; Humans ; Iliac Vein ; diagnostic imaging ; injuries ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Young Adult

A term "mesoesophagus" has been often used by surgeons, but the morphology was not described well. To better understand the structures attaching the human abdominal and lower thoracic esophagus to the body wall, we examined serial or semiserial sections from 10 embryos and 9 fetuses. The esophagus was initially embedded in a large posterior mesenchymal tissue, which included the vertebral column and aorta. Below the tracheal bifurcation at the fifth week, the esophagus formed a mesentery-like structure, which we call the "mesoesophagus," that was sculpted by the enlarging lungs and pleural cavity. The pneumatoenteric recess of the pleuroperitoneal canal was observed in the lowest part of the mesoesophagus. At the seventh week, the mesoesophagus was divided into the upper long and lower short parts by the diaphragm. Near the esophageal hiatus, the pleural cavity provided 1 or 2 recesses in the upper side, while the fetal adrenal gland in the left side was attached to the lower side of the mesoesophagus. At the 10th and 18th week, the mesoesophagus remained along the lower thoracic esophagus, but the abdominal esophagus attached to the diaphragm instead of to the left adrenal. The mesoesophagus did not contain any blood vessels from the aorta and to the azygos vein. The posterior attachment of the abdominal esophagus seemed to develop to the major part of the phrenoesophageal membrane with modification from the increased mass of the left fetal adrenal. After postnatal degeneration of the fetal adrenal, the abdominal esophagus might again obtain a mesentery. Consequently, the mesoesophagus seemed to correspond to a small area containing the pulmonary ligament and aorta in adults.
Adrenal Glands ; Adult ; Aorta ; Azygos Vein ; Blood Vessels ; Diaphragm ; Embryonic Structures* ; Esophagus* ; Fetus* ; Humans ; Ligaments ; Lung ; Membranes ; Mesentery ; Pleural Cavity ; Spine

Here we present the case of an 11-year-old female patient diagnosed with Caroli syndrome, who had refractory esophageal varices. The patient had a history of recurrent bleeding from esophageal varices, which was treated with endoscopic variceal ligation thrice over a period of 2 years. However, the bleeding was not controlled. When the patient finally visited the Emergency Department, the hemoglobin level was 4.4 g/dL. Transhepatic intrajugular portosystemic shunt was unsuccessful. Subsequently, the patient underwent percutaneous transhepatic variceal obliteration. Twenty hours after this procedure, the patient complained of aphasia, dizziness, headache, and general weakness. Six hours later, the patient became drowsy and unresponsive to painful stimuli. Lipiodol particles used to embolize the coronary and posterior gastric veins might have passed into the systemic arterial circulation, and they were found to be lodged in the brain, kidney, lung, and stomach. There was no abnormality of the portal vein on portal venography, and blood flow to the azygos vein through the paravertebral and hemiazygos systems was found to drain to the systemic circulation on coronary venography. Contrast echocardiography showed no pulmonary arteriovenous fistula. Symptoms improved with conservative management, and the esophageal varices were found to have improved on esophagogastroduodenoscopy.
Aphasia ; Arteriovenous Fistula ; Azygos Vein ; Brain ; Caroli Disease* ; Child ; Dizziness ; Echocardiography ; Emergencies ; Endoscopy, Digestive System ; Esophageal and Gastric Varices* ; Ethiodized Oil ; Female ; Headache ; Hemorrhage ; Humans ; Kidney ; Ligation ; Lung ; Phlebography ; Portal Vein ; Portasystemic Shunt, Surgical ; Stomach ; Stroke* ; Veins

Azygos Vein ; injuries ; Humans ; Male ; Middle Aged ; Thoracic Injuries ; complications ; Wounds, Nonpenetrating ; complications