Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Critical Care
Volume 2012, Article ID 147614, 3 pages
http://dx.doi.org/10.1155/2012/147614
Case Report

Conservative Management of Azygous Vein Rupture in Blunt Thoracic Trauma

1Emergency Department, St James’s Hospital, Dublin 8, Ireland
2Cardiothoracic Surgery Department, St James’s Hospital, Dublin 8, Ireland

Received 18 October 2012; Accepted 27 November 2012

Academic Editors: Y. Kluger and W. S. Park

Copyright © 2012 Cian McDermott et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of successful conservative management of acute traumatic rupture of the azygous vein. A 48-year-old male was involved in a motor vehicle collision. Primary survey revealed acute right intrathoracic haemorrhage. He remained haemodynamically stable with rapid infusion of warmed crystalloid solution and blood. Computed tomographic imaging showed a contained haematoma of the azygous vein. The patient was managed conservatively in the intensive care. Azygous vein laceration resulting from blunt thoracic trauma is a rare condition that carries a universally poor prognosis unless the appropriate treatment is instituted. Clinical features include acute hypovolaemic shock, widened mediastinum on chest radiograph, and a right-sided haemothorax. Haemodynamic collapse necessitates immediate resuscitative thoracotomy. Interest in this injury stems from the severity of the clinical condition, difficulty in diagnosis, the onset of a rapidly deteriorating clinical course all of which can be promptly reversed by timely and appropriate treatment. Although it is a rare cause of intramediastinal haemorrhage, it is proposed that a ruptured azygous vein should be considered in every trauma case causing a right-sided haemothorax or widened mediastinum. All cases described in the literature to date involved operative management. We present a case of successful conservative management of this condition.