Removal of aberrant azygos lobe containing positron emission tomography positive nodule with the use of video-assisted thoracic surgery

INTRODUCTION The Azygos lobe is a well-known but rare variant of the lung. This case reports the use of video-assisted thoracic surgery to diagnose and treat presumptive lung cancer of the azygos lobe. PRESENTATION OF CASE A 67-year old female with known severe Chronic Obstructive Pulmonary Disease presented with increasing shortness of breath. Chest x-ray revealed a lung nodule in the right lung field. PET/CT imaging delineated a 1.6 x 1.2 cm speculated lesion in an aberrant azygos lobe. After appropriate preoperative testing and evaluation, the patient was taken to the operating room where the azygos lobe was removed using video-assisted thoracic surgery. DISCUSSION The Azygos lobe is a well-known anatomical variant but such a lobe is rarely found to contain a malignant lesion. Azygos lobe removal alone may not be the best therapeutic option given the risk of locally recurrent disease, but in a select group of patients such as those with impaired lung function as this article describes, it may be the best available option in order to preserve postoperative pulmonary function. CONCLUSION This case illustrates that gentle caudal traction on the azygos lobe will allow circumferential exposure to the lobe and identification of the bronchovascular pedicle thereby eliminating the need for thoracotomy and or extensive azygos vein dissection/division.