Isolated azygos vein thrombosis: a rare phenomenon

Description

A 57-year-old man with diabetes mellitus and liver cirrhosis was electively admitted for endoscopic retrograde cholangiopancreatography (ERCP). He had history of obstructive jaundice secondary to choledocholithiasis in the preceding month, during which a biliary stent was inserted. During ERCP, he developed acute chest pain and shortness of breath. ECG, cardiac enzymes, coagulation profile and chest radiograph were normal. He was then suspected to have acute pulmonary embolism.

CT pulmonary angiography (CTPA) showed a central tubular filling defect within the azygos vein (AV). This filling defect has a small attachment at the roof of the vessel, forming acute angle with the vessel wall (figures 1 and 2). The rest of the pulmonary vasculature was fully opacified. Lung fields were normal.

Figure 1

Selected axial (A) and coronal (B) sections of CT pulmonary angiography showing tubular filling defect within the azygos vein (arrows).

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