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Congenital anomalies of respiratory system are quite diverse and not all of them are subject to surgical treatment. One example is accessory lobe of the azygos vein. This anomaly usually has no clinical manifestations and requires only follow-up, as well as attention in surgery on the right half of the chest for some other disease. This situation changes when complications occur, for example, purulent-inflammatory process. Therapy is not always effective, and lung tissue destruction requires surgical treatment. Progressive destruction complicates diagnosis and choosing surgical tactics. We present a rare case of severe purulent-inflammatory complication with abscess in accessory lobe of v. azygos . Anatomical abnormalities following this congenital pulmonary anomaly can cause difficulties in surgeries for other intra-thoracic diseases. The situation is especially relevant for thoracoscopic access. This report will be useful for radiologists, pulmonologists and thoracic surgeons.

Azygos vein aneurysm is a rare thoracic disease that often mimics posterior mediastinum tumors. Pathogenesis of azygos vein aneurysm is unclear. Discussions about possible causes are still ongoing. Most aneurysms are asymptomatic and diagnosed incidentally during standard examinations. Severe complications of azygos vein aneurysm include rupture with massive bleeding and pulmonary embolism. Contrast-enhanced chest CT and MRI are essential. Differential diagnosis includes tumors, cysts and rare neoplasms of the mediastinum. Treatment algorithm is not established. There are traditional surgical and endovascular methods. We present minimally invasive surgical treatment of azygos vein aneurysm in a 53-year-old woman. The patient underwent thoracoscopic resection of aneurysm. Histological examination revealed a partially thrombosed azygos vein aneurysm.

Two original organ-saving surgical technologies are suggested for surgical prophylaxis of bleedings from esophageal and gastric varicose veins dilatation. The azygoportal disconnection surgery has been performed at 42 patients. The rate of bleeding recurrences was 4.8%. This surgical procedure may be regarded as the stage of complex treatment of patients with liver cirrhosis and as the final treatment at the patients with extrahepatic portal hypertension.

The surgical bypass of v. azygos and v. pulmonalis sup. dext. to decompress the lesser circulation after extensive resections of the lung is elaborated. The operation was performed on 21 patients for cancer of the right lung, and in one patient with bilateral disease. The shunting followed pneumonectomy in 11 cases, the lower bilobectomy in 7, the upper lobectomy in 2. In 1 patient the operation was performed after successive left-sided lower lobectomy and right-sided upper lobectomy. The shunting reduced the middle pressure in the lung artery by 13,9-21,0% of the postresection level. The bypass did not cause statistically significant decrease of the oxygenation in the arterialized capillary blood.