J Korean Soc Radiol.  2019 Sep;80(5):942-952. 10.3348/jksr.2019.80.5.942.

The Anomalous Left Brachiocephalic Vein in Adults

• Yoo HW
• Kim YT

• KMID: 2459019
• DOI: http://doi.org/10.3348/jksr.2019.80.5.942

Abstract

PURPOSE
To classify anomalous left brachiocephalic vein (LBCV) in adult without cardiac anomaly, and evaluate CT findings of anomalous LBCV.
MATERIALS AND METHODS
This study included 32 patients who were diagnosed anomalous LBCV using MDCT between March 2005 and August 2016. Subaortic LBCV divided into group I (with normal LBCV) and group II (without normal LBCV). We evaluated age, sex, diameters and diameter ratios of superior vena cava (SVC) and subaortic LBCV, the entering sites to SVC of subaortic LBCV and the azygos vein, and vascular tortuosity of subaortic LBCV.
RESULTS
There were included 29 subaortic LBCV and 3 retroesophageal LBCV. There were not statistically significant in age, sex, diameter of SVC between subaortic groups (p > 0.05). The diameters of subaortic LBCV were thinner in group I. Diameter ratios of subaortic LBCV were lower in group I. The entering site of subaortic LBCV was higher than azygos vein in group I (64%) and same as azygos vein in group II (67%). Vascular tortuosity of subaortic LBCV was in 7 cases of group I.
CONCLUSION
It is important for radiologists to be familiar with CT findings of anomalous LBCV, since the radiologists give information of uncommon or rare anomalous LBCV to clinician.

MeSH Terms

Adult*
Azygos Vein
Brachiocephalic Veins*
Embryology
Humans
Vena Cava, Superior

Figure

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  Fig. 1 Types of anomalous LBCVs. Anomalous LBCV includes subaortic and retroesophageal LBCVs. Subaortic LBCV is defined as an anomalous LBCV passing beneath the aortic arch and anterior to the trachea and esophagus regardless of the presence of a normal LBCV, because the normal venous structure entering the superior vena cava is not in the subaortic area. Therefore, a subaortic LBCV is classified into two types according to the presence of a normal LBCV. Retroesophageal LBCV is defined as an anomalous LBCV passing inferiorly along the aortic arch and running posterior to the trachea and esophagus without the presence of a normal LBCV, because the LBCV communicates with the azygos vein through the left superior intercostal vein and accessory hemiazygos vein in some individuals with a normal LBCV. Ao = aorta, LBCV = left brachiocephalic vein, PA = pulmonary artery, S = superior vena cava

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  Fig. 2 Subaortic LBCV with a normal LBCV in a 64-year-old woman. A, B. Serial axial (A) and volume-rendering (B) images show a normally positioned LBCV (arrows) and a subaortic LBCV (arrowhead; A) draining to the superior vena cava. A small subaortic LBCV has a curvilinear course (arrowheads; B). The maximum diameter and diameter of the entering site of the subaortic LBCV are 6.07 mm and 5.82 mm respectively. The mean diameter of the superior vena cava is 15.95 mm. LBCV = left brachiocephalic vein, S = superior vena cava

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  Fig. 3 Subaortic LBCV without a normal LBCV in a 43-year-old man. A. Serial axial images show a subaortic LBCV (arrowheads) running between the ascending thoracic aorta and trachea. A normally positioned LBCV is absent anterior to the aortic arch and thoracic great vessels. The maximum diameter and diameter of the entering site of the subaortic LBCV are 15.39 mm and 7.3 mm, respectively. The mean diameter of the superior vena cava is 17.99 mm. B. Coronal slab MIP and posterior volume-rendering images show that an subaortic LBCV (arrowheads) passes below the aortic arch and posterior to the ascending thoracic aorta, draining to the superior vena cava. LBCV = left brachiocephalic vein, MIP = maximum intensity projection, S = superior vena cava

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  Fig. 4 Tortuous subaortic LBCV in a 74-year-old man. A tortuous subaortic LBCV is well visualized on the initial axial CT (arrowheads), but it cannot be seen on the follow up CT. This difference is caused by the injection site of the intravenous contrast media. When the initial CT was performed, intravenous contrast media was injected through the left arm. The follow up CT was performed after injection of intravenous contrast media through the right arm. On the follow up CT, the unenhanced subaortic LBCV mimics mediastinal lymph nodes. LBCV = left brachiocephalic vein

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  Fig. 5 Subaortic LBCV with the right aortic arch in a 42-year-old man. Serial axial images show a right-sided aortic arch (arrow) and a subaortic LBCV (arrowheads) draining to the superior vena cava. LBCV = left brachiocephalic vein, S = superior vena cava

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  Fig. 6 Retroesophageal LBCV in a 57-year-old man. A. Serial axial images show a subaortic LBCV (arrowheads) running lateral to the aortic arch and posterior to the descending thoracic aorta and esophagus and draining to the superior vena cava through the azygos vein (open arrowhead). A normally positioned LBCV is absent. B. Oblique axial slab MIP and volume-rendering image with a left lateral view show a retroesophageal LBCV (arrowheads) looping around the aortic arch and descending thoracic aorta and joining the azygos vein (open arrowheads). LBCV = left brachiocephalic vein, MIP = maximum intensity projection, S = superior vena cava

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  Fig. 7 Retroesophageal LBCV in a 78-year-old man. A. Volume-rendering image with a left lateral view shows the retroesophageal LBCV (arrowhead) running medial to the Ao. Note the thyroidal veins (arrows) between the thoracic great vessels. B. On serial axial images, an anomalous LBCV (arrowheads) passes medial to the Ao and turns posterior to the esophagus, joining the azygos vein (open arrowhead) before draining to the superior vena cava. A normally positioned LBCV is absent. Note the thyroidal veins (arrows) between the thoracic great vessels. Ao = aortic arch, LBCV = left brachiocephalic vein, S = superior vena cava

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