Today we review an azygos vein. This vein, which drains the spinal cord via intercostal veins and lumbar veins, enters the superior vena cava at the top, the renal vein in the middle and the ascending lumbar veins at the bottom.
The findings of malformations are
1. valvular problems of fixation, stiffness and fusion
2. Webs & septations running through the ascending component of the vein
3. twists and kinks
Let's have a look at this:
1. on the left contrast media is injected at the tip of the catheter (red arrow). One notes that there is no dye flowing up toward the superior vena cava.
2. on the second image one sees that there is dye above the area of blockage (red arrows). This is flowing past the obstruction through a large feeding branch. (orange curved arrow)
3. On the third image the narrowed segment is quite obvious. For those readers who are not obvious and have real moral character, the red arrow points to the pointed narrowing.
4. Finally, the last image on the right SHOWS NO NARROWING. What could be the explanation?
Tomorrow we will continue this harrowing adventure.
This is Dr Whiplash, i am out to lunch.
So, to get back to this. (and to allow me to play curious med-school wanna-be who couldn't stand blood so had to choose another career path doctor, for a little bit)
The images below show:
1. shows the ascending lumbar veins (bottom) and the mystery "stenosis" of the azygos vein (red arrow) a few vertebrae up?what vertebrae level would this be at?
Also in image 1, there appears to be some dark outline shadowy parts on the image that appear to be the hip bones ... is that correct?
2. shows the "stenosis" of the azygos vein again, what vertebrae level would this be at? and is that the hemi-azygos feeding the dye above the stenosis? or is it a "bypass" vein - a colleteral?
I'm not sure if we've moved up the azygos or if it's at the same arrow level as the first picture (the wire seems to be shorter in the 2nd image than the 1st) ... that's why I ask.
3. again, a more in tight view of the "stenosis" of the azygos ... what vertebrae level would this be at?
(I realize the answer to all the vertebrae levels are going to be the same)
4. This image is the most interesting to me - for the many questions I have. I've had a hard time finding real pictures of what the azygos looks like online, so here go my questions ...
So the picture starts with the ascending lumbar veins (correct)?
Then the left vertical vein is the azygos (correct)?
And the right vertical vein (along which the yellow arrow runs) is the hemi-azygos (correct)?
In addition to that, there is a little knob (you can see it in image 1 and image 4) on the azygos above which the "stenosis" is in image one. WHAT IS THAT?
I notice there is a (what seems to be) connection of the hemi-azygos (the right vein) and the azygos (the left vein if I'm correct) about 1/2 way up the yellow arrow line. Is that common? Because that seems to be just above where the "stenosis" is in the azygos.
Lastly, the hemi-azygos ends in the azygos (typically) at about T9 vertebrae ... is that where the arrow head of the yellow line is in this case? (so I can assume that's at or near T9?)
end of image related questions, now some commentary and thought provoking questions
Just trying to figure out the anatomy in this case ... and what veins this picture is actually showing us.
Then maybe after that we can figure out what around there might be causing this "stenosis" of the azygos vein.
And ... final question ... wouldn't constant proper flow through the azygos vein be important or necessary for the health of the spinal area? Isn't the backwash caused by an issue (valvular or ortherwise) in the jugulars what (theoretically) causes damage in the CCSVI model?
So if there is that backwash of sometimes working sometimes not blood in the azygos ... isn't that the same thing?
The veins in image 4 look healthy when working properly (inspiration I guess) ... but in image 1 they show CCSVI characteristics.
(maybe we'll discuss via PM instead?) but I think showing the anatomy to people is indeed important.