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Chylothorax is defined as the accumulation of chyle in the pleural space, mainly by damaging to the thoracic duct. 99m Tc-Dextran is a relatively new tracer for lymphoscintigraphy. A 40-year-old woman had recurrent chylothoraxes after thymoma resection and ligation of the thoracic duct owing to intraoperative suspected thoracic duct injury. She underwent lymphoscintigraphies using 99m Tc-sulfur colloid and 99m Tc-dextran, respectively, to identify the possible leakage site of the thoracic duct. The images showed increased 99m Tc-dextran but unimpressive 99m Tc-sulfur colloid activity at the leakage site. Based on the results, this patient received surgery anastomosing the thoracic duct and the azygos vein., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Connection of the right pulmonary veins to the azygous is an extremely rare variant of partial anomalous pulmonary venous connection. We describe one such case in the setting of an intact atrial septum. Surgical correction in such a situation can be challenging. We describe a successful surgical approach for this unusual variant., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

We report a resection of an azygos vein aneurysm that formed a thrombus during a 6-year follow-up period. An azygos vein aneurysm is commonly detected as an asymptomatic mediastinal mass. A thrombus could suddenly form without enlarging the aneurysm. Therefore we suggest that even asymptomatic azygos vein aneurysms causing blood stagnation should be resected before they can form a thrombus and cause a pulmonary embolism., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A 17-year-old girl visited our hospital for an operation to correct a partial anomalous pulmonary venous return. All the right-side pulmonary veins returned to the azygos vein, which had no connection to the cardiac chamber through the great venous system, such as the superior or inferior vena cava. The azygos vein lacked a normal azygos arch and was connected by multiple connections only to the paravertebral plexus. For the surgical correction, a pericardiostomy was created in the right posterior pericardial wall and azygos vein which was divided at the diaphragm level and was anastomosed to the left atriotomy area through the pericardiostomy site., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Partial anomalous pulmonary venous drainage (PAPVD) to the azygous vein and benign posterior mediastinal hemangioma in adults are both rare entities in isolation. The coexistence of these two lesions in the same patient has not been reported. We describe a unique case of PAPVD to the azygous vein in an adult woman, where the anomalous left inferior pulmonary vein transited first through a large hemangioma, and then eventuated in the azygous vein., (Copyright © 2011. Published by Elsevier Inc.)

Loss of central venous access in intestinal failure patients is a potentially fatal complication, and an indication for intestinal transplantation. Thrombosis of the superior vena cava (SVC) has historically been considered a contraindication to small bowel transplantation; however, unconventional central venous access can facilitate survival and eventual transplant procedure in patients with end-stage central venous access. We describe a technique for azygos vein central catheter insertion utilizing thoracoscopic guidance in a 14-year-old girl with thrombosis of the SVC and chronic idiopathic pseudo-obstruction syndrome awaiting multivisceral transplantation. The technique is simplified by utilizing carbon dioxide (CO(2)) insufflation of the thoracic cavity to collapse the lung instead of double-lumen endotracheal tube placement, and no postoperative chest tube drainage of the pleural space is required. Thoracoscopic-assisted central access can also be used in children requiring chronic hemodialysis with limited venous sites due to thrombosis or small size of vessels.

Background: Portal hypertension is a common disease and its major surgical therapeutic approaches include devascularization and shunting. This study was undertaken to investigate the effects of combined splenocaval or mesocaval C shunt and portoazygous devascularization (combined procedures) on portal hypertension., Methods: The clinical data of 150 patients with portal hypertension who had undergone combined procedures at the First Affiliated Hospital of Zhengzhou University from May 1990 to May 2003 were analyzed retrospectively., Results: The mean free portal pressure (FPP) was 25.6+/-1.83 mmHg, 18.0+/-2.07 mmHg and 18.4+/-2.19 mmHg before operation, after splenectomy plus splenocaval or mesocaval C shunt, and combined procedures, respectively. There was no operative death in all patients. The 1-7 year follow-up of 100 patients showed rebleeding in 3 patients, encephalopathy in 4, thrombosis of artificial vascular graft in 3, and dying from liver failure in 2., Conclusions: The combined procedures can not only decrease portal pressure but also preserve hepatic blood flow to some extent. It may be one of the best choices for treating portal hypertension in China.

We report the case of a living-donor lobar lung transplantation in which we found an abnormal segmental vein in the right lower lobe of the donor lung. The abnormal vein was anastomosed to the azygos vein of the recipient so that lung edema and congestion could be avoided. This alternative technique is effective in living-donor lobar lung transplantation when the superior segmental vein in the right lower lobe of the donor drains into the superior vein.

The development of pulmonary arteriovenous malformations after cavopulmonary bypass in patients with congenital heart disease is well documented. We report successful management of pulmonary arteriovenous malformations after cavopulmonary bypass in a patient with an interrupted inferior vena cava (IVC) and multiple hepatic veins utilizing an extracardiac conduit from the hepatic veins to the hemiazygous continuation of the interrupted IVC. This technique, performed without circulatory arrest or an atriotomy, may limit morbidity associated with intracardiac procedures in patients with single ventricle morphology. Furthermore, this case suggests an alternative technique for completion Fontan in patients with an interrupted IVC and multiple hepatic venous drainage.

We report an unusual case of a patient with diminished cardiac output caused by systemic venous occlusions of unclear etiology with a history of idiopathic fibrosing mediastinitis and retroperitoneal fibrosis. On thoracic, abdominal, and pelvic venograms, the patient was previously known to have superior vena caval and infrarenal inferior vena caval occlusions. Subsequent studies revealed retrograde flow through the azygous and hemiazygous veins and numerous caval-portal anastomoses providing venous return from the upper and lower extremities. After an extensive hypercoagulable state work-up, no abnormalities were found. To relieve the symptoms, the patient underwent an elective right thoracotomy with azygous vein to right atrial bypass graft. The patient has had complete amelioration of the disabling symptoms and participates in many activities that he could not tolerate previously. Because this condition and procedure are unreported, we present a novel surgical treatment option to palliate symptoms caused by concurrent superior and inferior caval obstructions by improving venous return to the heart.

Pulmonary arteriovenous fistulae after a cavopulmonary anastomosis have been reported to resolve after hepatic venous return is included in the pulmonary circulation. We report a case in which the hepatic veins were redirected to the pulmonary circulation by connecting them directly to the azygous continuation of the inferior vena cava that had previously been connected to the right pulmonary artery. The patient's arterial saturation of 71% increased to 92% after 6 months.

A child with heterotaxia, azygous continuation of an interrupted inferior vena cava, single ventricle, and pulmonary atresia underwent the Kawashima modification of the Fontan procedure, which excluded hepatic venous return from the pulmonary blood flow. After the operation, the patient had development of pulmonary arteriovenous malformations, increasing cyanosis, and ventricular dysfunction. He underwent orthotopic heart transplantation at 7 years of age with prompt resolution of the pulmonary arteriovenous malformations.

Primary anomalies of the azygos vein generally result from intrathoracic tumor compression or inferior vena caval interruption with azygos vein continuation. Vascular malformations, although uncommon, can frequently mimic solid tumors and present as middle or posterior mediastinal masses. We present the case of an isolated giant azygos vein varix in an asymptomatic patient. Preoperative computed tomography and magnetic resonance imaging were not diagnostic in evaluating this patient's anatomy.

Absence of the inferior vena cava (IVC) is an uncommon congenital abnormality. Symptoms of lower extremity venous insufficiency resulting from this anatomic abnormality have been reported only once in the English literature, and no experience with surgical treatment of this condition has been published. We report the case of an otherwise healthy 41-year-old man with an 18-month history of severe venous insufficiency involving the right leg manifested by extensive ulceration that did not respond to aggressive conservative treatment. Duplex findings were not suggestive of venous obstruction or reflux, but venography documented no filling of the common iliac vein or inferior vena cava, and outflow was via collaterals to the azygous and hemiazygous systems. Computed tomography demonstrated complete absence of the inferior vena cava with azygous continuation. A prosthetic bypass from the external iliac to the intrathoracic azygous vein was performed with complete symptomatic relief after a 30-month follow-up period. Venous bypass surgery may play a role in treatment of this rare cause of venous insufficiency.

Although the classical approaches for mitral valve surgery have remained standard over the years, variations have been described and implemented in an attempt to improve exposure of the mitral valve apparatus. A technical alternative that affords excellent exposure of the roof of the left atrium, allowing for an enlarged left atriotomy and precluding the need for more radical surgical maneuvers and their potential complications, is described.

A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has been the accepted mode of treatment for patients with complex cyanotic congenital heart disease. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were considered less than "ideal" candidates for a Fontan procedure. We divided the patients into two groups: group 1 had azygos continuation and group 2 did not. Fourteen patients required hypothermic cardiopulmonary bypass. Bidirectional pulmonary blood flow was achieved in all patients. Only 1 death occurred (group 2). The improvement in oxygen saturation and overall clinical condition of these patients, together with the low mortality and morbidity, is encouraging. However, long-term follow-up is mandatory for a comprehensive evaluation of this surgical approach as definitive palliation or as a first stage for a Fontan operation.