Intrahepatic Interruption of the Inferior Vena Cava with Azygos Continuation (Persistent Right Cardinal Vein)

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Abstract
It has been widely mentioned that the azygos vein may sometimes be noted on routine roentgenograms of the chest as a small ovoid density at the level of the aortic arch on the right side. In the normal subject, this should not exceed 6.0 mm in diameter. A density of unusual proportions suggesting a tumefactive process is certainly uncommon, and if it occurs tumor should be excluded if possible. The presenting shadow is rather characteristic and can be diagnosed conclusively without resorting to thoracotomy. The authors report a case in which the so-called giant azygos vein resulted from a persistent right cardinal vein with infrahepatic interruption of the inferior vena cava with azygos continuation. The condition was conclusively proved by femoral ileal venography following thoracotomy. The right cardinal vein was demonstrated draining into an enlarged azygos system. It is recommended that in cases with apparent enlarged azygos vein, femoral ileal venography or intraosseous venography be employed to demonstrate the azygos continuation of the anomalous inferior vena cava, thus preventing thoracotomy.

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