CTICasesAzygos Fissure Variant with Superior Intercostal Vein
Imaging findings
Chest CT shows a typical-appearing azygos fissure in the right upper lobe. However, the normal azygos vein arch is absent, and the fissure is instead occupied by an anomalous right superior intercostal vein that courses vertically to drain directly into the systemic venous system.
Key takeaways
This is a rare anatomic variant of the classic azygos lobe and fissure where the pleural fold invaginates around a superior intercostal vein rather than the azygos vein itself. Recognizing this variation prevents it from being misidentified as pathology, a mediastinal mass, or lymphadenopathy.
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