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The azygos vein is a key component of the venous system in the thorax, draining blood from the posterior chest and abdominal walls into the superior vena cava. Anatomical variations in the azygos vein, particularly its bifurcation, have been noted in numerous cadaveric studies and imaging reports. While typically a singular structure, the azygos vein can occasionally bifurcate into two separate trunks, each draining into different segments of the superior vena cava or even the right atrium. This article explores the clinical consequences of azygos vein bifurcation, including implications for thoracic surgeries, radiological interventions, and potential diagnostic challenges. Understanding the anatomical variations and their impact on clinical procedures is crucial for preventing complications and ensuring optimal patient outcomes.