Azygos vein aneurysm with thrombosis and aspergillus fumigatus diagnosed using bronchoscopy: Case report

Patient: Female, 86-year-old Final Diagnosis: Aspergillus fumigatus infection • azygos vein aneurysm with thrombosis Symptoms: Acute respiratory failure • paresthesia Medication: — Clinical Procedure: Bronchoscopy Specialty: Critical Care Medicine • General and Internal Medicine • Pulmonology Objective: Unusual clinical course Background: The venous system of the posterior thoracic wall merges into a single trunk called the azygos vein, located in the posterior mediastinum, before draining into the superior vena cava. An aneurysm in the azygos vein is ex-tremely rare. Such aneurysms are discovered as incidental radiology findings or while investigating a medias-tinal mass. Visualization via bronchoscopy is atypical. Case Report: An 86-year-old female patient presented to the Emergency Department with a 5-day complaint of dyspnea and chest pain. She was admitted because of worsening condition leading to respiratory failure and paresthesias. She underwent endotracheal intubation and invasive mechanical ventilatory support. A chest X-ray showed a thickened mediastinum, tortuous thoracic aorta, and bilateral perihilar infiltrate with right predominance. Bronchoscopy revealed bleeding along the right bronchus and a blue protrusion coated with white material at the entrance of the main right bronchus. A pulmonary computed tomography angiography confirmed the pres-ence of an azygos vein dilatation. Culture of bronchoalveolar lavage revealed Aspergillus fumigatus. Conclusions: Bronchoscopy as a diagnostic method allows clinicians to verify the state and permeability of the airways during investigation of azygos vein aneurysms, which are rare entities but should be considered in the differen-tial diagnosis of mediastinal masses and may be complicated by fungal pathogens such as Aspergillus fumig-atus mostly in immunocompromised patients.