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A rare anatomical variation detected incidentally on computed tomography of the thorax: the azygos lobe

Yıl 2021, , 93 - 97, 23.04.2021
https://doi.org/10.30565/medalanya.847756

Öz

Aim: An azygos lobe is an unusual anatomical variation of the upper lobe of the right lung. During the formation of the lungs, the right azygos lobe develops as the precursor of the azygos vein, moving along the pleural surface rather than arcing forward above the origin of the lung to reach the upper vena cava, enters the apex of the right lung in the upper thoracic region. The purpose of this study was to assess the prevalence of the right azygos lobe in a sample of the Turkish population.

Methods: This study was conducted from February to October 2020. Each computed tomography (CT) scan was checked for the presence of a right azygos lobe and a fissure on the axial plane. The azygos lobe was described as the convex line in the paramediastinal portion of the upper right lung on the CT scan. Our exclusion criteria were previous thoracic surgery in the right lung or parenchymal distortion on CT examinations.

Results: One thousand nine hundred and sixty-five thorax CT scans were evalu¬ated retrospectively. Nine hundred and forty-five of them were from men and the remainder were from women. A total of 15 right azygos lobe variations were detected (six females, nine males). The mean age of the patients was 52.87 ± 14.604 years (30–77). The azygos lobe frequency was 0.76%.

Conclusion: The azygos lobe is typically an uncommon variation of the right lung and is not really a distinct lobe. It is a very important variation that should be known about as it can mimic pathological conditions such as cysts, abscesses, or lung le¬sions. Since the azygos lobe is usually an incidental finding, radiologists and sur¬geons should be aware of this this potential anomaly during the imaging and inter¬ventional procedures.

Kaynakça

  • 1. Gill AJ, Cavanagh SP, Gough MJ. The azygos lobe: an anatomical variant encountered during thoracoscopic sympathectomy. Eur J Vasc Endovasc Surg. 2004;28(2):223-4. doi: 10.1016/j.ejvs.2004.02.011. PMID: 15234706.
  • 2. Rauf A, Rauf WU, Navsa N, Ashraf KT. Azygos lobe in a South African cadaveric population. Clin Anat. 2012;25(3):386-90. doi: 10.1002/ca.21243. PMID: 21800377.
  • 3. Arakawa T, Terashima T, Miki A. A human case of an azygos lobe: determining an anatomical basis for its therapeutic postural drainage. Clin Anat. 2008;21(6):524-30. doi: 10.1002/ca.20679. PMID: 18661573.
  • 4. Pradhan G, Sahoo S, Mohankudo S, Dhanurdhar Y, Jagaty SK. Azygos Lobe - A Rare Anatomical Variant. J Clin Diagn Res. 2017;11(3):TJ02. doi: 10.7860/JCDR/2017/25238.9505. PMID: 28511480.
  • 5. Akhtar J, Lal A, Martin KB, Popkin J. Azygos lobe: A rare cause of right paratracheal opacity. Respir Med Case Rep. 2018;23:136-137. doi: 10.1016/j.rmcr.2018.02.001. PMID: 29719800.
  • 6. Ndiaye A, Ndiaye NB, Ndiaye A, Diop M, Ndoye JM, Dia A. The azygos lobe: an unusual anatomical observation with pathological and surgical implications. Anat Sci Int. 2012;87(3):174-8. doi: 10.1007/s12565-011-0119-5. PMID: 22033832.
  • 7. Sieber W, Karcara N, Pant P. Pulmonary azygous lobe--an anatomical variant. Kathmandu Univ Med J. 2014;12(46):151-2. doi: 10.3126/kumj.v12i2.13665. PMID: 25552224.
  • 8. Perincek, G, Avci, S, Çeltikçi, P. Azygos Lobe Detected by Thoracic Computed Tomography and Frequency of Concomitant Variations. Journal of Enam Medical College. 2019; 9(3), 177-180. doi:10.3329/jemc.v9i3.43247
  • 9. Caceres J, Mata JM, Andreu J. The azygos lobe: normal variants that may simulate disease. Eur J Radiol. 1998;27(1):15-20. doi: 10.1016/s0720-048x(97)00146-0. PMID: 9587765.
  • 10. Kotov G, Dimitrova IN, Iliev A, Groudeva V. A Rare Case of an Azygos Lobe in the Right Lung of a 40-year-old Male. Cureus. 2018;10(6):e2780. doi: 10.7759/cureus.2780. PMID: 30112256.
  • 11. Minniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol. 2002;12(8):2040-55. doi: 10.1007/s00330-001-1241-x. PMID: 12136323.
  • 12. Özdemir L, Ozdemir B, Duman, T. Prevalence of an Azygos Lobe using Thoracic Computed Tomography. Cyprus J Med Sci 2016; 1(3): 55-571. doi: 10.5152/cjms.2016.97.
  • 13. Al-Mnayyis A, Al-Alami Z, Altamimi N, Alawneh KZ, Aleshawi A. Azygos Lobe: Prevalence of an Anatomical Variant and Its Recognition among Postgraduate Physicians. Diagnostics (Basel). 2020;10(7):470. doi: 10.3390/diagnostics10070470. PMID: 32664403.
  • 14. Koksal Y, Unal E, Aribas OK, Oran B. An uncommon extrapulmonary sequestration located in the upper posterior mediastinum associated with the azygos lobe in a child. J Thorac Cardiovasc Surg. 2007;133(4):1110-1. doi: 10.1016/j.jtcvs.2006.10.073. PMID: 17382671.
  • 15. Cimen M, Erdil H, Karatepe T. A cadaver with azygos lobe and its clinical significance. Anat Sci Int. 2005;80(4):235-7. doi: 10.1111/j.1447-073X.2005.00116.x. PMID: 16333920.
  • 16. Salve VT, Atram JS, Mhaske YV. Azygos lobe presenting as right para-tracheal shadow. Lung India. 2015;32(1):85-6. doi: 10.4103/0970-2113.148463. PMID: 25624609.

Toraks Bilgisayarlı Tomografisinde Tesadüfen Saptanan Nadir Bir Anatomik Varyasyon: Azigos Lobu

Yıl 2021, , 93 - 97, 23.04.2021
https://doi.org/10.30565/medalanya.847756

Öz

Amaç: Azigos lob, sağ üst lobun nadir bir anatomik varyasyonudur .Akciğerlerin oluşumu sırasında, sağ azigos lob, prekürsör sağ akciğerin apeksinden azigos venin üst torasik kısmına girerek akciğerin orjin noktasının üzerinde ileriye doğru kıvrılarak vena kavaya ulaşmak yerine plevral yüzey boyunca hareket ederken gelişir.Bu çalışmanın amacı, bir Türk popülasyonu örnekleminde sağ azigos lobunun preva¬lansını değerlendirmektir.

Yöntem: Bu çalışma Şubat 2020'den Ekim 2020 tarihleri arasında gerçekleştiril¬di. Bilgisayarlı tomografi (BT) görüntüleri, aksiyel düzlemde sağ azigos lob ve fissür varlığı açısından kontrol edildi. Azigos lob, BT taramasında sağ akciğerin üst paramediastinal kısmındaki konveks çizgi olarak tanımlandı. Dışlama kriterlerimiz, sağ akciğerden daha önce göğüs cerrahisi geçirmiş olan ya da BT incelemelerinde parankimal distorsiyonu bulunan vakalardı.

Bulgular: 1965 toraks BT taraması retrospektif olarak değerlendirildi. Vakaların 945'i erkek, kalanı kadındı. Toplam 15 sağ azigos lob varyasyonu tespit edildi (6 kadın, 9 erkek). Hastaların yaş ortalaması 52.87 ± 14.604 (30-77) idi. Azigos lob frekansı% 0.76 olarak bulundu.

Sonuç: Azigos lob, tipik olarak sağ akciğerin nadir görülen bir varyasyonu olup gerçek bir lob değildir. Kistler, apseler veya akciğer lezyonları gibi patolojik durumları taklit edebileceği için bilinmesi gereken oldukça önemli bir varyasyondur. Azigos lob genellikle insidental bir bulgu olduğundan, görüntüleme ve girişimsel işlemler sırasın¬da radyologlar ve cerrahlar bu anomalinin varlığı açısından dikkatli olmalıdır.

Kaynakça

  • 1. Gill AJ, Cavanagh SP, Gough MJ. The azygos lobe: an anatomical variant encountered during thoracoscopic sympathectomy. Eur J Vasc Endovasc Surg. 2004;28(2):223-4. doi: 10.1016/j.ejvs.2004.02.011. PMID: 15234706.
  • 2. Rauf A, Rauf WU, Navsa N, Ashraf KT. Azygos lobe in a South African cadaveric population. Clin Anat. 2012;25(3):386-90. doi: 10.1002/ca.21243. PMID: 21800377.
  • 3. Arakawa T, Terashima T, Miki A. A human case of an azygos lobe: determining an anatomical basis for its therapeutic postural drainage. Clin Anat. 2008;21(6):524-30. doi: 10.1002/ca.20679. PMID: 18661573.
  • 4. Pradhan G, Sahoo S, Mohankudo S, Dhanurdhar Y, Jagaty SK. Azygos Lobe - A Rare Anatomical Variant. J Clin Diagn Res. 2017;11(3):TJ02. doi: 10.7860/JCDR/2017/25238.9505. PMID: 28511480.
  • 5. Akhtar J, Lal A, Martin KB, Popkin J. Azygos lobe: A rare cause of right paratracheal opacity. Respir Med Case Rep. 2018;23:136-137. doi: 10.1016/j.rmcr.2018.02.001. PMID: 29719800.
  • 6. Ndiaye A, Ndiaye NB, Ndiaye A, Diop M, Ndoye JM, Dia A. The azygos lobe: an unusual anatomical observation with pathological and surgical implications. Anat Sci Int. 2012;87(3):174-8. doi: 10.1007/s12565-011-0119-5. PMID: 22033832.
  • 7. Sieber W, Karcara N, Pant P. Pulmonary azygous lobe--an anatomical variant. Kathmandu Univ Med J. 2014;12(46):151-2. doi: 10.3126/kumj.v12i2.13665. PMID: 25552224.
  • 8. Perincek, G, Avci, S, Çeltikçi, P. Azygos Lobe Detected by Thoracic Computed Tomography and Frequency of Concomitant Variations. Journal of Enam Medical College. 2019; 9(3), 177-180. doi:10.3329/jemc.v9i3.43247
  • 9. Caceres J, Mata JM, Andreu J. The azygos lobe: normal variants that may simulate disease. Eur J Radiol. 1998;27(1):15-20. doi: 10.1016/s0720-048x(97)00146-0. PMID: 9587765.
  • 10. Kotov G, Dimitrova IN, Iliev A, Groudeva V. A Rare Case of an Azygos Lobe in the Right Lung of a 40-year-old Male. Cureus. 2018;10(6):e2780. doi: 10.7759/cureus.2780. PMID: 30112256.
  • 11. Minniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol. 2002;12(8):2040-55. doi: 10.1007/s00330-001-1241-x. PMID: 12136323.
  • 12. Özdemir L, Ozdemir B, Duman, T. Prevalence of an Azygos Lobe using Thoracic Computed Tomography. Cyprus J Med Sci 2016; 1(3): 55-571. doi: 10.5152/cjms.2016.97.
  • 13. Al-Mnayyis A, Al-Alami Z, Altamimi N, Alawneh KZ, Aleshawi A. Azygos Lobe: Prevalence of an Anatomical Variant and Its Recognition among Postgraduate Physicians. Diagnostics (Basel). 2020;10(7):470. doi: 10.3390/diagnostics10070470. PMID: 32664403.
  • 14. Koksal Y, Unal E, Aribas OK, Oran B. An uncommon extrapulmonary sequestration located in the upper posterior mediastinum associated with the azygos lobe in a child. J Thorac Cardiovasc Surg. 2007;133(4):1110-1. doi: 10.1016/j.jtcvs.2006.10.073. PMID: 17382671.
  • 15. Cimen M, Erdil H, Karatepe T. A cadaver with azygos lobe and its clinical significance. Anat Sci Int. 2005;80(4):235-7. doi: 10.1111/j.1447-073X.2005.00116.x. PMID: 16333920.
  • 16. Salve VT, Atram JS, Mhaske YV. Azygos lobe presenting as right para-tracheal shadow. Lung India. 2015;32(1):85-6. doi: 10.4103/0970-2113.148463. PMID: 25624609.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Enes Gürün 0000-0002-5321-8439

İsmail Akdulum 0000-0001-6109-5240

Yayımlanma Tarihi 23 Nisan 2021
Gönderilme Tarihi 27 Aralık 2020
Kabul Tarihi 12 Şubat 2021
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

Vancouver Gürün E, Akdulum İ. A rare anatomical variation detected incidentally on computed tomography of the thorax: the azygos lobe. Acta Med. Alanya. 2021;5(1):93-7.

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