Successful Endovascular Treatment of a Large Idiopathic Azygos Arch Aneurysm

Idiopathic azygos vein aneurysms are rare and typically present as incidentally discovered mediastinal masses. Treatment is advisable when the aneurysm enlarges or is complicated by compression symptoms, rupture, or thromboembolic disease. The authors describe successful endovascular treatment of a symptomatic azygos vein aneurysm by means of embolization with coils at the azygos vein close to the dilated arch but respecting the bulb itself. The patient reported symptoms of cough, wheezing, and persistent hiccups, and the procedure resulted in thrombosis of the azygos vein and aneurysm retraction on imaging, accompanied by resolution of symptoms.