Abstract
The right azygos lobe is a rare anatomical variant of the upper lung lobe that can be misdiagnosed as a neoplasm, a lung abscess, or a bulla. The aim of this study was to assess the prevalence of right azygos lobe and to evaluate the ability of postgraduate doctors to correctly identify right azygos lobe. We analyzed a total of 1709 axial thoracic multi-detector computed tomography (CT) images for the presence of an azygos lobe. Additionally, a paper-based survey was distributed among a sample of intern doctors and radiology and surgery residents, asking them to identify the right azygos lobe in a CT image and in an anatomy figure. Results showed that the prevalence of the right azygos lobe in the study sample was 0.88%. Men have more right azygos lobes than women. None of the intern doctors or surgery residents identified the right azygos lobe correctly, whereas more than half (57.1%) of the radiology residents did. Most of the incorrect answers about the CT scan were related to the bronchi (25.0%). The apex of the lung (17.7%) and the superior vena cava (17.7%) were the most common incorrect answers about the anatomy figure. In conclusion, the prevalence of the right azygos lobe in the current study is within the range of previously published literature. More education should be given for the identification of the right azygos lobe during anatomy and clinical teaching.
Highlights
The right azygos lobe is an anatomical variant present in the upper lobe of the right lung, separated from the rest of the lung by a deep groove called an azygos fissure, which consists of the azygos vein and four layers of pleura.The right azygos lobe is formed during the development of the lungs when the precursor to the upper thoracic segment of the azygos vein, called the right posterior cardinal vein, penetrates the apex of the right lung, carrying along the pleural layers instead of arcing forward above the root of the lung as to enter the superior vena cava
The prevalence of the right azygos lobe in the Jordanian population was found to be 0.88%
None of intern doctors or surgery residents answered the questions identifying the right azygos lobe in computed tomography (CT) and anatomy images correctly
Summary
The right azygos lobe (lobus venae azygos) is an anatomical variant present in the upper lobe of the right lung, separated from the rest of the lung by a deep groove called an azygos fissure, which consists of the azygos vein and four layers of pleura (two parietal layers and two visceral layers).The right azygos lobe is formed during the development of the lungs when the precursor to the upper thoracic segment of the azygos vein, called the right posterior cardinal vein, penetrates the apex of the right lung, carrying along the pleural layers instead of arcing forward above the root of the lung as to enter the superior vena cava. The right azygos lobe is detected by conventional chest radiographs and by computed tomography (CT) scans [1,2,3]. The prevalence of the azygos lobe is 1.0% in anatomic specimens, about 0.4% in chest radiographs, and 1.2% in high-resolution CT scans [5,6]. Clinicians, anatomists, surgeons, and imaging practitioners should be aware of the possibility of the presence of a right azygos lobe. Since it is usually asymptomatic, its recognition is essential to prevent
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