Azygos vein aneurysm and thrombosis are rare. It resembles a mediastinal mass that can be seen by chest radiograph, computed tomography, and magnetic resonance imaging. This case describes an elderly woman with a mediastinal mass due to azygos vein aneurysm and thrombosis. She was diagnosed by non-invasive procedures. The etiology of the azygos vein aneurysm was portal hypertension secondary to liver cirrhosis. Re-canalization was established by non-invasive management.