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A 15-year-old boy was receiving chemotherapy for osteogenic sarcoma of the left femur. A routine chest radiograph incidentally showed an azygous lobe of the lung (Panel A) with a thin fissure (arrows) separating it from the rest of the right upper lobe. As part of an evaluation for lung metastases, computed tomography of the chest was performed 2 weeks later (Panels B and C). In addition to the fissure (Panel B, white arrows) and the contrast-enhanced azygos vein (Panel C, asterisk), a small nodule, 1 cm in diameter (Panel B, black arrow) was seen in the posterior right upper lobe. Evaluation of a specimen from a thoracoscopic lung biopsy (Panel D) showed that the membranous fissure (asterisk) contained the azygos vein (arrowheads) and divided the apex of the right hemithorax. The lung nodule was found to contain metastatic osteosarcoma. The patient recovered quickly from the biopsy and continues to receive chemotherapy.
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