Non-Azygos Accessory Fissure in Right Upper Lobe Associated with Superior and Inferior Accessory Fissures in Right Lower Lobe
A 40-year-old woman with a known diagnosis of extra-nodal (bone marrow, spleen, and pleural fluid) stage IV diffuse large B-cell lymphoma was referred for baseline PET-CT scan before the initiation of treatment. PET-CT scan showed diffuse increased fluorodeoxyglucose uptake in the marrow consistent with known marrow involvement by lymphoma, in addition to splenomegaly. Incidentally noted in the CT portion of the PET-CT was an accessory fissure in the right upper lobe. Prior dedicated CT scan of the chest was reviewed. The dedicated CT scan of the chest demonstrated the fissure better than the CT portion of the PET-CT, due to lack of breathing artifact and the accentuation caused by the pleural effusion. The accessory fissure was between the apical and anterior segments of the right upper lobe [Figures and ]. The contrast-enhanced CT scan showed normal location and course of the azygos vein []. In addition, the patient also had inferior and superior accessory fissures in the right lower lobe [Figures and ].