Azygos vein lacerations, a rare injury from high-impact chest trauma: Two cases and a review of the literature.

Abstract

IntroductionThoracic trauma is a significant cause of mortality, being responsible for 25% of trauma deaths. Despite this, azygos vein lacerations are rare, with only 35 published cases. We present two cases of azygos vein laceration over 21 years from 1999 to 2020 at a Level One Trauma Centre in Melbourne, Australia, as well as a review of the literature.Case presentationsThe first case is a 38-year-old male who fell eight metres from a motorbike jump. He arrived in our emergency department in extremis. The second case is an 81-year-old female driver who presented following a motor vehicle crash. Both patients had massive right haemothorax and haemodynamic instability, so were transferred to the operating theatre for emergency thoracotomies. Both patients survived to hospital discharge.DiscussionOf the 37 cases of azygos vein injury, including our two, 36 were due to blunt trauma and one from penetrating trauma. Sixteen survived to hospital discharge, producing a 43% mortality rate. Only one of these survivors was managed non-operatively, the remainder underwent emergency thoracotomy and azygos vein ligation. The mortality rate reduced to 31% in those who underwent thoracotomy (n = 29). Presentation was predominantly with shock (83%) and right hemithorax white-out on chest x-ray (81%).ConclusionAzygos vein injuries are a rare but important cause of thoracic haemorrhage in high-impact blunt trauma. They are often fatal, so management relies on expedient transfer to theatre.