The azygos vein and its pleural reflections. II. Applications in the radiological diagnosis of mediastinal abnormality

Azygoesophageal recess

Knowledge of the normal radiologic appearance and manifestations of disease in the azygoesophageal recess can facilitate the detection and diagnosis of intrathoracic disease. The azygoesophageal recess is located lateral or posterior to the esophagus and anterior to the spine. It extends from the anterior turn of the azygous vein to the aortic hiatus. The configuration of the azygoesophageal recess is normally a smooth arc convex to the left. Because the right lung extends into the recess, pathology in this region can often be detected radiographically and typically manifests as increased opacity and/or as a contour abnormality. In adults, convexity directed to the right and immediately below the level of the azygous vein on a frontal radiograph is abnormal and requires further evaluation.

Abnormalities of the azygo-oesophageal recess at computed tomography

The azygo-oesophageal recess is well demonstrated at CT. It may be distorted by pathologic processes in mediastinum, pleura and lung. Illustrations of the various conditions have been selected from 933 CT examinations.

Malignant versus benign paravertebral widening in children

Dorso-medial pleural reflection line anomalies occur in malignant tumours, neuroblastoma being the commonest one, in benign tumours, spinal inflammatory disorders and in cases of pseudotumours of different origin. The latter group comprises normal structure variants, malformations and acquired disease but also a small number of transitory or permanent lesions of uncertain or obscure origin. The radiological manifestations encountered are displacement, obliteration or blurring of the paraspinal contour, sometimes a frank paravertebral mass. Based on a case material consisting of 65 patients the importance of recognizing this feature is stressed. An approach to clinical and radiological diagnosis is discussed.