Thoracoscopic sympathetic clamping in a patient with an azygos fissure.

We believe that an azygos fissure may predispose to bleeding during thoracoscopic surgery. An azygos fissure causes important morphologic changes in the superior mediastinum and thereby poses a risk of massive bleeding during thoracoscopic procedures. We report on a successful thoracoscopic procedure conducted in a patient with palmar hyperhidrosis and an azygos fissure and emphasize that the course of the thoracic sympathetic chain runs laterally along the base of the azygos fissure.