Hidden lung findings in 10,000 patients presenting to anesthesia outpatient clinics for preoperative evaluation: Azygos Lobe
DOI:
https://doi.org/10.26900/hsq.2865Keywords:
Azygos lobe, anesthesia, congenital anomalyAbstract
The azygos lobe is usually considered to be a continuation of the upper lobe of the right lung. The azygos vein passes over the right main bronchus and is characterized by its distinct passage. This variation is not typically considered part of the normal anatomy of the right lung and can result in various clinical conditions. The prevalence of the azygos lobe varies among different populations, but it is generally reported to be between 0.1% and 1%. From an anatomical perspective, the azygos lobe, formed by the separate continuation of the right upper lobe bronchus, is an important structure to consider in surgery and anesthesia. Diagnosis is usually made using imaging techniques, and the presence of the azygos lobe should be carefully considered when planning and performing endotracheal intubation during induction of anesthesia. In 73 out of 10,000 patients, the presence of the azygos lobe may affect the anatomical structure of the airway during anesthesia management; therefore, ventilation strategies should be adjusted accordingly. Our study aims to determine the prevalence of the azygos lobe in patients attending the anesthesia clinic for preoperative. It also aims to raise awareness of radiologically missed anatomical variants and avoid unnecessary surgical delays and consultations by differentiating the azygos lobe from bullae, masses, or abscesses.
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Pedroni G, Albo G, Galbiati F, Borzani IM, Zanini A, Leva E, at al. Predictive role of venous drainage and lesion margins in bronchopulmonary sequestration classification. IJCM. 2025;14(9):3018. doi: 10.3390/jcm14093018.
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Guney G, Aydinli F, Aksit S, Kadirli K, Salmanoglu M. Heterotaxy Syndrome diagnosed in an adult. Ochsner J. 2024;24(4):288-97. doi: 10.31486/toj.24.0021.
Akar B, Coşkun ZK, Kaban YE, Ece D. A systematic literature study of anatomical variations in human lung fissures and hilar structures. Eur J Anat. 2024;28(1):131-43. doi: 10.52083/YPWC5380.
Wang Y, Ma G, Rao NN, Liu M, Liao J, Wang QY. Pulmonary sequestration associated with pulmonary actinomycosis: A case report and literature review. Medicine. 2024;103(40):e39981. doi: 10.1097/MD.0000000000039981.
Emekli E, Yıldırım M. Anatomical variations in fissure of the lung on computed tomography. OTJHS. 2023;8(4):470-5. doi: 10.26453/otjhs.1316356.
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Oliveira Bustamante LD, Amaral Gualberto VH, de Sa e Souza CF, dos Santos AS, Faria Magalhães Torres DD, Silva JG. Clinical and surgical implications of the pulmonary azygos lobe: A systematic review. Int J Morphol. 2022;40(2). Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-95022022000200442. (Accessed on Sep 07, 2025).
Kamble G, Roshan S, Shivarama C, Somesh M. Prevalence of azygos lobe of the lung in Southern Indian cadaveric population: A retrospective observational study. JCDR. 2024;18(2). doi: 10.7860/JCDR/2024/68678.19022.
Manjunath M, Sharma MV, Janso K, John PK, Anupama N, Harsha DS. Study on anatomical variations in fissures of lung by CT scan. Indian J Radiol Imag. 2021;31(04).797-804. doi: 10.1055/s-0041-1741045.
Guliyev UDEK, Başyiğit İ. Solunum Sistemi Hastalıklarında Semptomlar. Akciğer Hastalıklarında Anamnez [in Turkish]. 2023;39.
Yurasakpong L, Yammine K, Limpanuparb T, Janta S, Chaiyamoon A, Kruepunga N, et al. The prevalence of the azygos lobe: A meta‐analysis of 1,033,083 subjects. Clin Anatomy. 2021;34(6): 872-83. doi: 10.1002/ca.23737.
Perincek G, Avci S, Çeltikçi P. Azygos lobe detected by thoracic computed tomography and frequency of concomitant variations. J Enam Med Coll. 2019;9:177-80. doi: 10.3329/jemc. v9i3.43247.
Gürün E, Akdulum İ. A rare anatomical variation detected incidentally on computed tomography of the thorax: The azygos lobe. Acta Medica Alanya. 2021;5(1):93-7. doi: 10.30565/medalanya.847756.
Tosun M, Ölmez H. The prevalence of azygos lobe incidentally detected on lung x-ray in male police vocational school students: A cross-sectional study. Med J West Black Sea. 2022;6(2):137-41. doi: 10.29058/mjwbs.1106162.
Piciucchi S, Barone D, Sanna S, Dubini A. Goodman LR, Oboldi D, et al. The azygos vein pathway: An overview from anatomical variations to pathological changes. Insights Imag. 2014;5:619-28. doi: 10.1007/s13244-014-0351-3. DOI: https://doi.org/10.1007/s13244-014-0351-3
Pedroni G, Albo G, Galbiati F, Borzani IM, Zanini A, Leva E, at al. Predictive role of venous drainage and lesion margins in bronchopulmonary sequestration classification. IJCM. 2025;14(9):3018. doi: 10.3390/jcm14093018. DOI: https://doi.org/10.3390/jcm14093018
Omer SOB, Yelbuz TM, Alghamdi MH. Management of patients with heterotaxy syndrome. In Manual of Pediatric Cardiac Care: Volume I 2024;521-33 p. Singapore: Springer Nature Singapore. doi: 10.1007/978-981-19-8357-3-61. DOI: https://doi.org/10.1007/978-981-19-8357-3_61
Guney G, Aydinli F, Aksit S, Kadirli K, Salmanoglu M. Heterotaxy Syndrome diagnosed in an adult. Ochsner J. 2024;24(4):288-97. doi: 10.31486/toj.24.0021. DOI: https://doi.org/10.31486/toj.24.0021
Akar B, Coşkun ZK, Kaban YE, Ece D. A systematic literature study of anatomical variations in human lung fissures and hilar structures. Eur J Anat. 2024;28(1):131-43. doi: 10.52083/YPWC5380. DOI: https://doi.org/10.52083/YPWC5380
Wang Y, Ma G, Rao NN, Liu M, Liao J, Wang QY. Pulmonary sequestration associated with pulmonary actinomycosis: A case report and literature review. Medicine. 2024;103(40):e39981. doi: 10.1097/MD.0000000000039981. DOI: https://doi.org/10.1097/MD.0000000000039981
Emekli E, Yıldırım M. Anatomical variations in fissure of the lung on computed tomography. OTJHS. 2023;8(4):470-5. doi: 10.26453/otjhs.1316356. DOI: https://doi.org/10.26453/otjhs.1316356
Yentürk E. Torasi̇k cerrahi̇ hastalarinda akci̇ğer kaynakli fi̇ssür ve damar varyasyonlarinin retrospekti̇f anali̇zi̇ [in Turkish]. 2022;(Master's thesis, Bursa Uludag University, Türkiye).
Oliveira Bustamante LD, Amaral Gualberto VH, de Sa e Souza CF, dos Santos AS, Faria Magalhães Torres DD, Silva JG. Clinical and surgical implications of the pulmonary azygos lobe: A systematic review. Int J Morphol. 2022;40(2). Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-95022022000200442. (Accessed on Sep 07, 2025). DOI: https://doi.org/10.4067/S0717-95022022000200442
Kamble G, Roshan S, Shivarama C, Somesh M. Prevalence of azygos lobe of the lung in Southern Indian cadaveric population: A retrospective observational study. JCDR. 2024;18(2). doi: 10.7860/JCDR/2024/68678.19022. DOI: https://doi.org/10.7860/JCDR/2024/68678.19022
Manjunath M, Sharma MV, Janso K, John PK, Anupama N, Harsha DS. Study on anatomical variations in fissures of lung by CT scan. Indian J Radiol Imag. 2021;31(04).797-804. doi: 10.1055/s-0041-1741045. DOI: https://doi.org/10.1055/s-0041-1741045
Guliyev UDEK, Başyiğit İ. Solunum Sistemi Hastalıklarında Semptomlar. Akciğer Hastalıklarında Anamnez [in Turkish]. 2023;39.
Yurasakpong L, Yammine K, Limpanuparb T, Janta S, Chaiyamoon A, Kruepunga N, et al. The prevalence of the azygos lobe: A meta‐analysis of 1,033,083 subjects. Clin Anatomy. 2021;34(6): 872-83. doi: 10.1002/ca.23737. DOI: https://doi.org/10.1002/ca.23737
Perincek G, Avci S, Çeltikçi P. Azygos lobe detected by thoracic computed tomography and frequency of concomitant variations. J Enam Med Coll. 2019;9:177-80. doi: 10.3329/jemc. v9i3.43247. DOI: https://doi.org/10.3329/jemc.v9i3.43247
Gürün E, Akdulum İ. A rare anatomical variation detected incidentally on computed tomography of the thorax: The azygos lobe. Acta Medica Alanya. 2021;5(1):93-7. doi: 10.30565/medalanya.847756. DOI: https://doi.org/10.30565/medalanya.847756
Tosun M, Ölmez H. The prevalence of azygos lobe incidentally detected on lung x-ray in male police vocational school students: A cross-sectional study. Med J West Black Sea. 2022;6(2):137-41. doi: 10.29058/mjwbs.1106162. DOI: https://doi.org/10.29058/mjwbs.1106162
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