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2)Department of Thoracic Surgery, Shizuoka Hospital, Juntendo University, Shizuoka, Japan1)Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, JapanCorresponding author: Youichi YanagawaDepartment of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University1129 Nagaoka, Izunokuni City, Shizuoka 410-2295, JapanTEL: +81-55-948-3111　E-mail: yyanaga@juntendo.ac.jp〔Received　Mar. 1, 2022〕〔Accepted　Apr. 14, 2022〕J-STAGE Advance published date: Jul. 14, 2022Copyright © 2022 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ22-0010-CRJuntendo Medical Journal2022. 68(4), 398-404Key words: trauma, shock, azygos injury, outcomeCase reportsCase Report and Minireview of the Literature on Blunt Azygos InjuryIntroductionThe azygos vein is located on the right side of the vertebral column and penetrates from the retroperitoneum through the diaphragm to join the superior vena cava at the T4 level1). Fracture- dislocation of the mid-thoracic spine or ribs, as a result of blunt thoracic trauma, can tear the azygos vein1). The vein can also be torn, in the absence of skeletal injuries, by horizontal acceleration/decel-eration forces1). Most reports of blunt trauma to the azygos vein in the relevant literature are related to motor vehicle collisions1). Patients frequently present with shock-like symptoms and expanding hemothorax, necessitating prompt surgical repair1-28). Azygos vein injury seems to be an uncommon cause of hemothorax and hemomedi-astinum; however, this injury is potentially fatal. We herein report a fatal case of blunt azygos injury and a review of the relevant literature. The protocol of this retrospective study was approved by Juntendo Shizuoka Hospital review board (approval number: 298). We obtained oral informed consent from the bereaved.A 63-year-old man fell from a 2nd floor veranda while leaning over a banister trying to catch a ladder. When emergency medical technicians checked him, he was in shock state with conscious-ness disturbance; thus, he was transported to our emergency room (ER) by ambulance within 20 minutes. He had a medical history of diabetes mellitus and colon cancer. On arrival, his vital signs Ken-ichi MURAMATSU1), Kei JITSUIKI1), Shunki HIRAYAMA2), Youichi YANAGAWA1)　Azygos vein injury seems to be an uncommon cause of hemothorax and hemomediastinum; however, this injury is potentially fatal. We report a fatal case of blunt azygos injury and a PubMed search was undertaken to identify English articles from 1989 to 2022 using the key words “azygos”, “injury” and “blunt”. We found 28 articles about blunt azygos injury and 39 patients including the present case (average 41.2 years [range: 18-81 years]; male, n=20; female, n=19). The other variables were as follows: right hemothorax (n=32); unstable circulation on arrival (n=32); and survival (n=19; unknown, n=2). These cases were divided into two groups based on the outcome: the survival group and the fatal group. There were no significant differences with regard to the year of the report, age, sex, rate of right rib fracture, rate of preoperative computed tomography (CT) examination, rate of associated injury, and rate of operation. The rate of shock on arrival in the survival group was significantly lower than that in the fatal group. The rate of azygos arch injury in the survival group was significantly greater than that in the fatal group. The emergency physician must consider azygos vein injury as a possible cause of right hemothorax when a patient with blunt chest trauma presents persistent hypotension.398Case presentation