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Number 08-08 Incidental chest findings – is CT needed?
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Number 08-08 Incidental chest findings – is CT needed?

Case from: Caroline Coats, Derek Hausenloy, Maite Tome, James Moon. Department of Cardiology, The Heart Hospital, London, UK

History: A 54 yr old man with abnormal ECG and apical obliteration on LVgram but normal echo, was referred for CMR (possible apical hypertrophic cardiomyopathy).

CMR Findings:
1. Apical HCM confirmed (not shown)
2. Abnormality of the right upper lung, as shown.





Interpretation: No CT is needed. This is an azygous lobe, a normal variant and no further imaging is needed. The azygous lobe is a small accessory lobe above the hilum of the right lung, formed in fetal life when the azygous vein fails to migrate over the apex of the lung. It occurs in 1% of people and requires no specific treatment.

CMR perspective: An azygous lobe is just one incidental appearance on thoracic imaging that CMR doctors should be aware of. No confirmatory CT or CXR is needed. An appreciation of normal thoracic anatomy is vital for performing CMR.

Caceres J et al. The azygos lobe normal variants that may simulate disease, Eur J Radiol, 1998: 27, 15–20
Online Reference and CT images here

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