Azygos vein aneurysm as incidental finding

Abstract

A 47 year old female patient underwent computed tomography (CT) of the thorax as part of standard pretransplantation screening protocol. The patient suffered from decompensated liver cirrhosis and multifocal hepatocellular carcinoma (HCC). Patient underwent series of chemoembolisations for HCC and was subsequently placed on the transplantation list. Thoracic CT examination is a routine pretransplantatation examination in our hospital, because metastatic spread would be considered a contraindication for liver transplantation according to current guidelines. The study was performed in two phases, the standard unenhanced and the venous post-contrast phase. An oval mass in the upper paratracheal lymph node region was immediately noticed on the unenhanced scan and was initially thought to be an enlarged lymph node. On the post-contrast series the lesion displayed marked contrast uptake (> 100 HU) and it was clearly in connection with the azygos vein (Figure 1). Subsequent oblique multi-planar reconstructions (MPR) clearly displayed a fusiform aneurysmatic dilatation of the azygos vein, located at the junction of the azygos vein and the superior vena cava, measuring up to 25 × 16 × 18 mm (Figure 2). This incidental finding was not considered a contraindication to proceed with the liver transplantation and the patient was successfully operated several days after this study was performed.