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right hemothorax after blunt chest trauma due to traumatic azygous vein injury, likely from rupture of a pseudoaneurysm, was observed. Thus, the diagnosis of azygous vein injury without initial hemothorax can be hampered in extremely rare case16). These cases were divided into two groups: the survival group (n=19), which included cases in which the outcome was survival; and the fatal group (n=18), which included cases who died. The characteristics of the cases were compared between the two groups, including the year of the report, age, sex, rate of shock on arrival, rate of right rib fracture, rate of azygos arch injury, rate of preop-erative CT, rate of associated injury, and rate of operation. The chi-squared test, median test or non-paired Student’s t-test were used for the statistical analyses. P values of <0.05 were consid-ered to indicate statistical significance. The results of the analysis are shown in Table 2. There were no statistically significant differences with regard to the year of the report, age, sex, rate of right rib fracture, rate of preoperative CT examination, rate of associated injury and rate of operation. The rate of shock on arrival in the survival group was signifi-cantly lower than that in the fatal group, and the rate of azygos arch injury in the survival group was significantly greater than that in the fatal group.This review of cases of blunt azygos injury is the first report to suggest that shock on arrival and the location of azygos vein injury may have an influ-ence on final outcome of the patient. Shock on arrival in patients with blunt trauma Year of the reportAgeSex (male/female)Shock (%)Right rib fracture (%)Arch (%)CT (%)Associate injury (%)Operation (%)CT; computed tomographyTable 2　Comparison between the survival and fatal groupsSurvivaln = 19200042.7 ± 21.38/1114 (73)10/n=16 (62)12 (63)6 (46)15 (78)18 (94)201238.6 + 14.311/718 (100)10/n=17 (58)1/n=9 (11)4 (22)15 (83)18 (100)suggests massive bleeding from injured sites and/or spinal cord injury, and previous reports have also demonstrated that shock on arrival is a poor prognostic factor30, 31). Accordingly, ER physicians must consider azygos vein injury as a possible cause of right hemothorax in patients with blunt chest trauma who show persistent hypotension. The reason for the favorable outcome of azygos arch injury in comparison to other sites might be that it is easier to visually recognize the injured site. Usually, trauma patients are managed in supine position in the ER and tentative thora-cotomy is also performed in the same position because subsequent tentative laparotomy might be required to explore abdominal injuries32). The azygos arch was easily visually recognized in the supine position, however, other sites might be hidden by the pulmonary hilus, lung or diaphragm33). In the present hemostasis at the site of the azygos arch injury was obtained by direct gauze packing; however, the packing at the inferior injury site of the azygos vein was insufficient.This review of cases of blunt azygos injury failed to show that recent medical development has resulted in favorable outcomes. Recent surgeons are familiar with using preoperative radiological studies to perform a planned operation precisely, safely and less invasively. In contrast, experienced trauma surgeons can perform urgent surgical oper-ations without radiological studies, with manual intraoperative exploration to identify the site of bleeding and apply hemostasis34). Advanced Trauma Life Support® (ATLS®) does not recommend that trauma patients with unstable circulation be moved Fataln = 18p value0.240.770.240.010.820.0060.520.730.24401Discussion