A 67-year-old female active smoker was referred to Interventional pulmonology unit after incidental detection of a left perihilar mass on imaging. Positron Emission Tomography showed a left hilar pulmonary mass invading mediastinal fat, hypermetabolic lymphadenopathy (supraclavicular, paratracheal, bilateral hilar, subcarinal), and hypermetabolic T2-T3 vertebral lesions suggesting skeletal metastases. Bronchoscopy revealed left main bronchus infiltration; multiple biopsies were negative. Under general anesthesia. EBUS-TMC was performed, obtaining tissue from subcarinal and left hilar stations. During right paratracheal ultrasound, a hypoechoic intraluminal image (3.68mm×3.79mm) within the azygos vein was identified (video), suggestive of azygos vein thrombosis (AVT), along with a thrombus in the right pulmonary artery. These findings highlight the importance of systematic vascular assessment during EBUS, even in oncology procedures. AVT is rare and its etiopathogenesis remains unclear. The most frequent predisposing factor is azygos vein aneurysm (47.3%), followed by septic thrombosis (15.8%), and intravascular catheters (10.5%). Other associated conditions include congenital malformations or prothrombotic states. Although venous thromboembolism is common in cancer, AVT in this setting is exceptional, making its detection notable and clinically significant (Fig. 1).
CRediT authorship contribution statement
All the authors of the article have contributed substantially to the elaboration of the manuscript.
Declaration of generative AI and AI-assisted technologies in the writing processNo use of IA has been used to elaborate this scientific letter.
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