The azygos lobe: an unusual anatomical observation with pathological and surgical implications

The azygos lobe is a rare anomaly in broncho-pulmonary segmentation due to an unusual course of the azygos vein. Its radiological aspects are well known but there are few anatomical reports about its bronchial and vascular components. The authors describe the characteristic features in a particular case of the azygos lobe observed in the right lung after studying a fresh specimen and doing a casting of said specimen. This azygos lobe was in a position medial to the right upper lobe and above the hilum. It had the shape of an egg and was 5 cm high, 4 cm wide and 2 cm thick. The azygos fissure was of a vertical form. The lobe was ventilated by the posterior branch of the apical segmental bronchus (B1a). This latter was accompanied by two apical sub-segmental arteries (A1ai, A1aii) and the apical intersubsegmental vein (V1a). The new findings were that: first, the azygos lobe bronchus supplied a part of the right upper lobe; second, the passage of the azygos vein deformed the bronchus of the right upper lobe, and not that of the azygos lobe. This means that it was the right upper lobe, rather than the azygos lobe that was predisposed to the pathology. So, in excising this type of azygos lobe, particular precautions have to be taken to spare the bronchus of the azygos lobe that supplies the right upper lobe.