Absent Azygos Vein in a neonate with oesophageal atresia and tracheoesophageal fistula

Absent azygos vein is a rare anomaly of the venous system, which is commonly an incidental finding, with only few publications reporting it. Due to the scarcity of cases, it is rarely reported with oesophageal atresia ± tracheoesophageal fistula (OA ± TOF), which is usually accompanied with cardiac anomalies in up to 80% of the cases. This association has only been reported thrice in literature. We report a 6-day-old female who was referred to our centre after diagnosis of OA + TOF. The patient had no associated anomalies apart from small patent foramen ovale and small ventricular septal defect; however, there was no functional compromise. Upon thoracoscopic exploration, azygos vein could not be visualised. Thoracoscopic repair was performed, and the postoperative period was uneventful. On follow-up, the patient had no postoperative complications. Absent azygos vein is a rare anomaly with few cases reported throughout the literature. Azygos vein is considered an important landmark intraoperatively because it guides the surgeon to the TOF site. Moreover, it might be important in other patients with major cardiac anomalies with abnormal venous drainage who might need further surgical correction.