THE ABNORMAL AZYGOGRAM—AN INDEX OF INOPERABILITY

¹ From the Department of Radiology and Division of Thoracic Surgery, University of Maryland, School of Medicine, Baltimore, Maryland

Azygography has been performed on 86 patients with proven bronchogenic carcinoma in an effort to evaluate this procedure in assessing operability of lung cancer. The azygographic findings and the status of the mediastinum have been related surgically in 35 patients and by clinical and plain roentgen evidence in 51 patients. In general, it is fair to say that the azygogram adds little of an informative nature as to the status of the mediastinum than what is already known by clinical or plain roentgen means. In ascertaining resectability, a normal azygogram is of no value, while an abnormal azygogram is a strong indication of inoperability. Rather than discard and dismiss this simple roentgenologic procedure, it is believed that it should be applied to that situation in which clinical and/or plain roentgen evidence of mediastinal involvement by a suspected or known pulmonary malignancy is either equivocal or lacking; an abnormal azygogram in such an instance is felt to indicate spread of the malignant process beyond the limits of resectability. As an interesting sidelight, 1 case of granulomatous mediastinitis, 1 of sarcoidosis and 1 of lung abscess resulting in azygos vein obstruction were discovered although inflammatory intrathoracic lesions in the main do not alter the azygos venous system.

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