CTICasesTracheal Bronchus supplying Azygos Lobe with Top Pulmonary Vein Variant
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Imaging findings
Chest CT demonstrates an anomalous "top" pulmonary vein that drains the medial aspect of the right upper lobe (specifically the portion delineated by an azygos fissure) and courses posteriorly to the bronchus intermedius to enter the roof of the left atrium. Additionally, a separate, rudimentary supernumerary tracheal bronchus is identified arising directly from the lateral wall of the trachea and supplying the azygos lobe.
Key takeaways
Congenital anomalies of the tracheobronchial tree often co-occur with pulmonary vascular variants. The "top" pulmonary vein is a well-known anatomical variant that runs posterior to the bronchus intermedius and can drain anomalous segments. This case highlights a "variant of a variant," where a tracheal bronchus supplies an azygos lobe in association with a top pulmonary vein.
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