Azygos lobe in endoscopic thoracic sympathectomy for hyperhidrosis

Abstract

Before the introduction of endoscopic thoracic sympathectomy (ETS) for the management of hyperhidrosis, anomalous azygos lobes of the lung were rarely encountered. When performing ETS, it is important to have knowledge of and be prepared to deal with this anatomical anomaly. A database of 2,272 patients who underwent ETS was reviewed to determine the incidence of azygos lobe, describe the characteristics of patients with azygos lobe, and evaluate the outcomes. Twenty cases (0.9%) of azygos lobe were identified. Two distinctive variations were encountered, one in which proximal venous drainage was present (type 2) and one in which this downward drainage system did not exist (type 1). In type 2, the vein and veil must be retracted to obtain better exposure. All patients were treated endoscopically, without conversion to open thoracotomy. Palmar sweating was cured in all cases, and all of the patients reported satisfaction with the outcome. Azygos lobe occurs in 1% of the population and can make ETS more difficult. If the surgeon is prepared, there are effective techniques for performing the sympathectomy. The results are similar to those obtained in patients without this anatomical variation.