CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 30Abnormality of the
Azygoesophageal Recess on
Computed Tomography

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 30-1 Normal appearance. CT scan shows the
azygoesophageal recess (white arrow) formed by the
esophagus anteriorly (black arrow) and the azygos vein
posteriorly (arrowhead). The azygoesophageal line seen on
plain radiographs represents the interface between this
recess and the lung.52

4. • Fig C 30-2 Lymph node enlargement. (A) Enlargement of subcarinal lymph
nodes (arrow) in a patient with malignant lymphoma produces reversal of
the normal convexity at the level of the bronchus intermedius. The tumor
cannot be delineated from mediastinal structures. (B) In a different
patient with metastases from bronchogenic carcinoma of the right lower
lobe, a scan obtained during the infusion of intravenous contrast material
shows a distinct enlarged node (arrow) bulging into the recess at the level
of the middle lobe bronchus.60

5. • Fig C 30-3 Dilatation of the descending aorta. (A) The
aorta pushes lung away from the azygoesophageal
recess. (B) At the level of the bronchus intermedius in a
patient with a right-sided descending aorta, the
azygoesophageal recess is markedly distorted by the
descending aorta's bulging toward the right lung.60

6. • Fig C 30-4 Carcinoma of the esophagus. Feeding
tube in lumen. (A) At a level corresponding to the
ventricular cavities, there is thickening of the
esophageal wall with reversal of the normal
curvature of the azygoesophageal recess (arrow).
(B) At the level of origin of the middle lobe
bronchus, there is even more prominent bulging
into the right lung because of prestenotic
dilatation of the esophagus (arrow).59

7. • Fig C 30-5 Hiatal hernia. Large gas- and fluid-
filled structure (arrow) that causes a rightward
bulge of the distal azygoesophageal recess.63

8. • Fig C 30-6 Bronchogenic cyst. Subcarinal mass
(arrow) producing an abnormal convexity of
the azygoesophageal recess.52

9. • Fig C 30-7 Pleural mesothelioma. At the level of
the right main bronchus, irregular pleural-based
masses (arrow) that are most prominent
anteriorly cause posterior displacement of the
ascending aorta (A).60

10. • Fig C 30-8 Atelectasis. Collapse of the superior segment
of the right lower lobe from bronchogenic carcinoma
causes loss of demarcation between mediastinum and
lung at the level of the middle lobe bronchus.60