Azygos and hemiazygos veins
Assessment for aortic dissection. Bicuspid aortic valve and chest pain.
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Beautiful retrograde filling of azygos and hemiazygos veins via a right cubital fossa intra-venous injection of radiographic contrast. Azygos vein rejoins the SVC in the chest and arises from the IVC posteriorly at the level of the right renal vein. The hemiazygos vein arises from a lumbar vein in the upper lumbar region and joins the azygos in the mid posterior medistinum.
Azygos veins do not usually fill so dramatically on CT chest but in this the case the large volume of contrast used (150mls) and high injection rate of 5ml/sec (in order to produce a dense aortogram) has led to contrast reflux into the azygos vein via the SVC.