Congenital anomalous azygos vein drainage causing pulmonary embolus in a 91-year-old patient

Low , K.E; Premathilake, P; Pullaperuma, L; Angel, T

Congenital anomalous azygos vein drainage causing pulmonary embolus in a 91-year-old patient

Authors

Low , K.E

Premathilake, P

Pullaperuma, L

Angel, T

Issue Date

2021

Type

Scientific Paper

Keywords

Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine

Abstract

Abstract Background: Retroaortic course and azygos continuation of aberrant left brachiocephalic vein is a rare venous anomaly, which is usually associated with congenital heart disease and pulmonary artery anomalies. Venous stasis is a cause of pulmonary arterial thromboembolism, which can result from venous anomalies. Case presentation: We describe the case of a 91-year-old female admitted to our hospital with shortness of breath diagnosed with pulmonary embolism and infarctions by a CT pulmonary angiogram. CT also showed aberrant left brachiocephalic vein with vascular webs at its retroaortic course and azygos continuation, suggesting chronic venous thrombosis, which was considered to be the suspected source of emboli. Conclusion: To our knowledge, this is the first report presenting this vascular anomaly manifesting with chronic venous thrombosis and pulmonary embolism. Although rare, awareness and identification of this entity is important, especially in the absence of obvious embolic sources or in patients with recurrent embolus/consolidation. Learning points: Awareness of congenital anomalous drainage anatomy is important even if there has been a relatively benign clinical course.Alterations in morphology due to age and degenerative change may result in altered flow predisposing to chronic embolic phenomena.Recurrent consolidation may not necessarily be due to infection in the elderly, a recurrent embolic phenomenon may also be a cause, in this case without a common cause such as deep vein thrombosis. Keywords: Aortic anomalies; chronic thromboembolic disease; elderly patients. © EFIM 2021. PubMed Disclaimer Conflict of interest statement Conflicts of Interests: The authors declare there are no competing interests. Figures Figure 1 Figure 1 Volume-rendered image of the retroaortic… Figure 2 Figure 2 Pulmonary web in the retroaortic… Figure 3 Figure 3 Chronic thrombus seen as a… Figure 4 Figure 4 Mosaic attenuation in the lungs… Figure 5 Figure 5 Right ventricular enlargement supporting chronic… Similar articles Congenital absence of inferior vena cava with azygos continuation revealed by vascular echo in a patient with pulmonary thromboembolism and deep vein thrombosis: a case report. Namisaki H, Nishigami K, Murakami M, Yamamoto T, Ogata Y, Tomita A. Ann Vasc Dis. 2013;6(2):195-7. doi: 10.3400/avd.cr.12.00104. Epub 2013 Apr 11. PMID: 23825501 Free PMC article. Double Inferior Vena Cava with Azygos Continuation and Retroaortic Left Renal Vein Associated with Juxtarenal Abdominal Aortic Aneurysm Surgery. Onoda K, Shomura Y, Komada T. Ann Vasc Dis. 2018 Mar 25;11(1):123-126. doi: 10.3400/avd.cr.17-00083. PMID: 29682119 Free PMC article. Postcorrective surgery improvement of nocturnal hypoxemia in a case of partial anomalous pulmonary venous connection and aberrant hepatic vein drainage. Agrawal A, Palkar AV, Sahni S, Vatsia SK, Shah RD, Talwar A. Lung India. 2016 May-Jun;33(3):306-9. doi: 10.4103/0970-2113.180871. PMID: 27185995 Free PMC article. Congenital systemic venous return anomalies to the right atrium review. Oliveira JD, Martins I. Insights Imaging. 2019 Dec 4;10(1):115. doi: 10.1186/s13244-019-0802-y. PMID: 31802263 Free PMC article. Review. An extremely rare case report of surgery of lung cancer with the absence of azygos vein. Atari M, Nakajima Y, Fukuhara M, Iijima Y, Kinoshita H, Minamiya Y, Uramoto H. Surg Radiol Anat. 2017 Jan;39(1):103-106. doi: 10.1007/s00276-016-1704-z. Epub 2016 Jun 4. PMID: 27262308 Review. See all similar articles References Azizova A, Onder O, Arslan S, Ardali S, Hazirolan T. Persistent left superior vena cava: clinical importance and differential diagnoses. Insights Imaging. 2020;11:110. - PMC - PubMed Verma M, Pandey NN, Ojha V, Kumar S, Ramakrishnan S. Developmental anomalies of the superior vena cava and its tributaries: what the radiologist needs to know? Br J Radiol. 2021;94:20200856. - PMC - PubMed Olry R, Lellouch A. The arterial system of the Japanese anatomist Buntaro Adachi. Hist Sci Med. 2003;37(1):89–94. - PubMed Minami M, Noda M, Kawauchi N, Shirouzu I, Nakajima J, Araki T, et al. Postaortic left innominate vein: radiological assessment and pathogenesis. Clin Radiol. 1993;48(1):52–56. - PubMed Kim SH, Chung JW, Im JG, Choi YW, Choe YH, Han MC. Subaortic left innominate vein: radiologic findings and consideration of embryogenesis. J Thorac Imaging. 1999;14(2):142–146. - PubMed Show all 11 references Related information MedGen LinkOut - more resources Full Text Sources Europe PubMed Central PubMed Central

Citation

Low, K. E., Premathilake, P., Pullaperuma, L., Angel, T. (2021) Congenital anomalous azygos vein drainage causing pulmonary embolus in a 91-year-old patient. European Journal of Case Reports in Internal Medicine. 8(11): 002978. DOI: https://dx.doi.org/10.12890/2021_002978