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29 July 2020 : Case report  Ecuador

Azygos Vein Aneurysm with Thrombosis and Aspergillus fumigatus Diagnosed Using Bronchoscopy: Case Report

Unusual clinical course, Management of emergency care, Rare disease, Rare coexistence of disease or pathology

Killen H. Briones-Claudett123ABCDEFG*, Mónica H. Briones-Claudett23ABCDEF, Alex Posligua Moreno3ABDE, Bertha J. López Briones3ABCD, Killen H. Briones Zamora4ADEF, Diana C. Briones Marquez1ADEF, Jaime Bemites Sólis3ADEFG, Juan S. Crespo5CDEF, Michelle Grunauer56ACEFG

DOI: 10.12659/AJCR.923401

Am J Case Rep 2020; 21:e923401

Abstract

BACKGROUND: The venous system of the posterior thoracic wall merges into a single trunk called the azygos vein, located in the posterior mediastinum, before draining into the superior vena cava. An aneurysm in the azygos vein is extremely rare. Such aneurysms are discovered as incidental radiology findings or while investigating a mediastinal mass. Visualization via bronchoscopy is atypical.

CASE REPORT: An 86-year-old female patient presented to the Emergency Department with a 5-day complaint of dyspnea and chest pain. She was admitted because of worsening condition leading to respiratory failure and paresthesias. She underwent endotracheal intubation and invasive mechanical ventilatory support. A chest X-ray showed a thickened mediastinum, tortuous thoracic aorta, and bilateral perihilar infiltrate with right predominance. Bronchoscopy revealed bleeding along the right bronchus and a blue protrusion coated with white material at the entrance of the main right bronchus. A pulmonary computed tomography angiography confirmed the presence of an azygos vein dilatation. Culture of bronchoalveolar lavage revealed Aspergillus fumigatus.

CONCLUSIONS: Bronchoscopy as a diagnostic method allows clinicians to verify the state and permeability of the airways during investigation of azygos vein aneurysms, which are rare entities but should be considered in the differential diagnosis of mediastinal masses and may be complicated by fungal pathogens such as Aspergillus fumigatus mostly in immunocompromised patients.

Keywords: Aneurysm, Infected, Aspergillus fumigatus, Azygos Vein, Aged, 80 and over, Aneurysm, Aspergillosis, Bronchoalveolar Lavage Fluid, Bronchoscopy, computed tomography angiography, Venous Thrombosis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923