The congenital azygous with its suspensory azygous web is an anatomic variant that can obscure visualization of the superior sulcus of the right hemithorax during various thoracic surgical procedures. Four patients who underwent thoracoscopic sympathicotomy for massive palmoplantar hyperhidrosis were discovered to have this irregularity. All patients underwent curative and uneventful sympathectomy procedures despite the presence of the aberrant azygous lobe and web. The precise anatomic details and surgical management are described here in detail.

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