CTICasesAzygos Defibrillator Lead in an Azygos Fissure
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Imaging findings
Chest x-ray shows a markedly enlarged heart with a defibrillator in place, including right ventricular and right atrial leads. An additional defibrillator lead takes an unusual course: it is located medially but then heads posteriorly and descends along the spine, consistent with an azygos vein course. On the frontal view, this lead initially courses lateral to the mediastinum before looping back around. A prior CT scan confirms the presence of an azygos fissure containing the azygos vein, through which the defibrillator lead courses before entering the superior vena cava.
Key takeaways
An azygos defibrillator lead is an anatomical variant sometimes used in device placement. The presence of an azygos fissure, a congenital anomaly, creates a unique anatomical pathway for such leads, often visible on imaging. Recognizing this variant course prevents misinterpretation and helps understand complex lead placements in patients with defibrillators.
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