Circumaortic Left Brachiocephalic Vein: CT Findings

Abstract

The brachiocephalic vein is formed by the internal jugular vein and the subclavian vein. The left brachiocephalic vein (LBCV) usually passes superior and anterior to the aortic arch (1). In rare cases, this vein follows an anomalous course. This anomaly was first described by Kerschner in 1888 (2) and a double LBCV described by Takata in 1992 (3). The incidence of an aberrant left brachiocephalic vein (ALBCV) with congenital heart disease is 0.15-0.98%, whereas in the general population, the incidence of this condition has been reported to be from 0.06 to 0.37% (4). In this report, we describe the computed tomography (CT) findings of circumaortic LBCV. Case ReportA 53-year-old male presented with chest wall pain. He underwent chest CT scan with 5-mm section thicknesses using a multidetector CT scanner (Aquilion 64, Toshiba Medical Systems, Tokyo, Japan). The images were acquired within a single breath hold after injection of the contrast medium (Iobrix 350; injection rate, 2.2 mL/sec; volume, 100 mL).The CT scan revealed lung cancer in the right upper lobe. Incidentally, the CT identified an ALBCV that was divided into two branches at the level of the aortic arch (Fig. 1). The anterior branch was above the aortic arch and coursed anterior to the left common carotid artery and brachiocephalic artery, before draining into the superior vena cava (SVC). The posterior branch was below the aortic arch and coursed posterior to the ascending aorta. Both branches drained into the SVC separately and no other cardiovascular anomaly was noted. The patient refused further evaluation and operation. DiscussionThe brachiocephalic veins are two large vessels at the junction of the neck and thorax, which result from union of the internal jugular and subclavian veins in the

Types of left brachiocephalic vein aberrations detected during cardiac implantable electronic device implantation procedures

“…An abnormal, supraaortic variant of the typically subaortic course of the left BCV in the superior mediastinum was first described by Takada et al [22]. Other left-BCV variants due to the vessel's abnormal embryogenesis have also been described: a double left BCV, formed when a doubled branch of the left BCV courses inferoposteriorly to the ascending aorta before anastomosing with the right BCV or when the accessory vessel courses posteriorly to the trachea and esophagus and merges with the azygos vein before draining into the SVC [23,24]. In our study, we encountered the following left-BCV variants: subaortic left BCV, double left BCV, and another, previously unreported, variant where both vessels (the upper and lower one) coursed parallel to each other above the aortic arch [25].…”

Innominate vein vascular ring provides novel insight into systemic venous embryogenesis

“…1 Duplicate innominate veins were first described by Takada et al 2 in 1992, and to date only four cases have been reported worldwide. [2][3][4] The development of the innominate vein occurs in the seventh embryonic week. 3 Several theories regarding the embryogenesis of the innominate vein have been proposed.…”

Surgical Management of Lesions encountered in the Setting of the Retroaortic Left Brachiocephalic Vein

“…12,13 We encountered 6 descriptions of the duplication of the vein, the branches encircling the aorta, and one report of persistent left superior caval vein with duplication of the left brachiocephalic vein. 17,31,43,[45][46][47] In one of the cases, the anterior and thinner vein coursed above the aortic arch, anterior to left common carotid artery, and then passed between the left common carotid artery and brachiocephalic trunk to join the right superior caval vein. The posterior thicker retroaortic vein coursed posterior to trachea and esophagus and joined the azygous vein at the level of the second thoracic vertebra before draining to the right superior caval vein.…”

“…Three-dimensional computed tomographic angiocardiography, and magnetic resonance imaging, are helpful in ascertaining the diagnosis, and in demonstrating the relationship of the vein to the adjacent structures (Figures 1A-1F, 3A-3C, 4A-4C). [3][4][5]9,10,14,15,17,22,25,[27][28][29][32][33][34][35][36][43][44][45][46]59,69 Cardiac catheterization and angiography may still be indicated in doubtful cases, and for evaluation of associated cardiac anomalies. 13,20,28,48,55,57,74 Computed tomography and magnetic resonance imaging similarly come into their own for the assessment of associated lesions.…”

“…Both veins in this variant drain separately into the superior caval vein (Figure 5H). 17,18,23,[43][44][45][46][47] From the 250 reported cases we were able to identify, three-quarters with associated congenitally malformed hearts. Of these 189 patients, all but 7 had usual atrial arrangement.…”