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Year : 2016  |  Volume : 33  |  Issue : 1  |  Page : 95-96  

Mediastinal widening: An interesting quiz

1 Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital, Delhi, India
2 Department of Pulmonary Medicine, Sharda Medical College and Hospital, Sharda University, Noida, India
3 Department of Pulmonary Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
4 Department of Hospital Management, Singhania University, Rajasthan, India

Date of Web Publication4-Jan-2016

Correspondence Address:
Rakesh K Chawla
Chawla Respiratory, Allergy, Sleep Disorder and Research Centre, 58-59/C-12/Sector-3, Rohini, Delhi - 110 085
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-2113.173079

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How to cite this article:
Chawla RK, Madan A, Chawla A, Chawla K. Mediastinal widening: An interesting quiz. Lung India 2016;33:95-6

How to cite this URL:
Chawla RK, Madan A, Chawla A, Chawla K. Mediastinal widening: An interesting quiz. Lung India [serial online] 2016 [cited 2021 Feb 27];33:95-6. Available from: https://www.lungindia.com/text.asp?2016/33/1/95/173079

   Case History Top

A 60-year-old non-smoker obese female and a known diabetic was admitted to a tertiary care hospital with altered sensorium. She complained of fatigue, nausea, polydypsia, polyuria and shortness of breath. She was awake but confused; her speech, vision and deglutition reflexes were normal. Her pulse rate was 110/minute, regular with good volume, BP 102/72 mmHg, respiratory rate 24/minute and oxygen saturation of 97% on room air. Respiratory and cardiac examinations did not reveal any abnormality. Overall, she was clinically stable. There were no engorged neck veins, tender hepatomegaly, dependent edema, distended superficial veins, or other evidences of cardiac or hepatic disease. Also, there was absence of headache, epistaxis, visual disturbances, hoarseness of voice, tongue swelling, hemetemesis or hemoptysis. Blood analysis (including a hemogram, differential cell count, hepatic and renal functions) was within normal limits. ECG showed regular tracings. USG abdomen did not show any organomegaly or fluid in serous membranes. Her random blood sugar was 440 mg%; pH 7.3, pCO2 32 mmHg and HCO3 was 18 meq/L. Ketone bodies were positive on urine exam. She was managed on the lines of DKA with IV insulin infusion @ 8 IU/hour, 2 liters of saline in first 2 hours followed by remaining 2 liters in 24 hours along with potassium supplementation and recovered completely. Incidentally, however, her routine chest radiograph showed right mediastinal opacity with widening of the mediastinum mimicking a mediastinal tumor [Figure 1].
Figure 1: X-Ray Chest showing mediastinal widening

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   Question Top

What is the diagnosis?

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   References Top

Dudiak CM, Olson MC, Posniak HV. CT evaluation of congenital and acquired abnormalities of the azygos system. Radiographics 1991;11:233-46.  Back to cited text no. 1
Paoletti F, Pellegrino V, Antonelli M, Ripani U, Mosca S, Durì D, et al. Compensatory dilatation of the Azygos Venous system Secondary To Superior Vena Cava Occlusion. J Radiol Case Rep 2009;3:49-55.  Back to cited text no. 2
Kim CY, Mirza RA, Bryant JA, Whiting ED, Delong DM, Spritzer CE, et al. Central veins of the chest: Evaluation with time-resolved MR angiography. Radiology 2008;247:558-66.  Back to cited text no. 3
Seebauer L, Präuer HW, Gmeinwieser J, Sebening F. A mediastinal tumor simulated by a sacculated aneurysm of the azygos vein. Thorac Cardiovasc Surg 1989;37:112-4.  Back to cited text no. 4
Ko SF, Huang CC, Lin JW, Lu HI, Kung CT, Ng SH, et al. Imaging features and outcomes in 10 cases of idiopathic azygos vein aneurysm. Ann Thorac Surg 2014;97:873-8.  Back to cited text no. 5
Kurihara Y, Nakajima Y, Ishikawa T. Case report: Saccular aneurysm of the azygos vein simulating a paratracheal tumor. Clin Radiol 1993;48:427-8.  Back to cited text no. 6
Gallego M, Mirapeix RM, Castañer E, Domingo C, Mata JM, Marín A. Idiopathic azygos vein aneurysm: A rare cause of mediastinal mass. Thorax 1999;54:653-5.  Back to cited text no. 7
Mohammad K, Bhaskar N, Siddiqui MF. Idiopathic azygos vein aneurysm mimicking a mediastinal mass: Case report and review of literature. J Med Cases 2013;4:292-5.  Back to cited text no. 8
Jain A, Blebea JS. Post-traumatic pseudoaneurysm of the azygous vein in a patient with azygous continuation. J Comput Assist Tomogr 1994;18:647-8.  Back to cited text no. 9


  [Figure 1], [Figure 2]


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