IS case 472: Azygos vein enlargement secondary to pulmonary arterial hypertension and right-sided heart failure

Gurpreet Dhillon, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is a 59-year-old female with history of pulmonary arterial hypertension and right heart failure secondary to severe emphysema.

Findings

Azygos vein enlargement secondary to pulmonary arterial hypertension and right-sided heart failure.

Diagnosis

Azygos vein enlargement secondary to pulmonary arterial hypertension and right-sided heart failure

Discussion

Azygos vein enlargement is defined as an azygos vein measuring greater than 7 mm diameter on an upright chest radiograph. It can be secondary to a number of different disease states involving two primary categories: a need for collateral circulation and engorgement due to right atrial hypertension. The azygos vein becomes a collateral vessel in the following states: portal hypertension, SVC obstruction/compression below the azygos vein, IVC obstruction/compression, interrupted IVC with azygos continuation, and partial anomalous venous return. Azygos enlargement is seen with right atrial hypertension in right-sided heart failure, constrictive pericarditis, and large pericardial effusion.

The patient in this case had incidental azygos vein enlargement secondary to pulmonary arterial hypertension and right-sided heart failure.

References

  1. Burgener FA, Kormano M, Pudas T. The Chest X-ray (Differential Diagnosis in Conventional Radiology). New York: Thieme; 1997.
  2. Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M. Venous anomalies of the thorax. AJR Am J Roentgenol. 2004 May;182(5):1139-50. PMID: 15100109

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