RIGHT SITED MEDIASTINAL WIDENING AT CONGENITAL CONTINUOUS AZYGOS VEIN SYNDROME

in a 55-year-old female patient who was admitted to hospital for diagnosis and treatment of arterial hypertension, the postero-anterior chest x-ray showed right-sided mediastinal widening with smooth borders. There were no symptoms of malignancy or signs of an inflammatory process. The CT scan demonstrated widening of the azygos vein to approximately 3.5 x 2.0 cm. Since the intrahepatic segment of the inferior vena cava was absent, a congenital continuous azygos vein syndrome was diagnosed. Ultrasonography showed the course of the dilated azygos vein from above the level of the renal veins to where it passes through the diaphragm. Moreover, the hepatic veins open directly into the right atrium. The congenital continuous azygos vein syndrome is an anomaly without any haemodynamic effects, and is usually a secondary diagnosis. It is clinically relevant in excluding an acquired continuous azygos vein syndrome (e.g. in malignant obstruction of the inferior vena cava), differential diagnosis of space-occupying mediastinal lesions, and the search for associated heart defects (e.g. ventricular septal defect).