J Korean Soc Radiol.  2018 Sep;79(3):161-165. 10.3348/jksr.2018.79.3.161.

Incidentally Found Absence of the Left Brachiocephalic Vein with Venous Return Through the Left Superior Intercostal Vein in an Adult Patient: Venography and CT Findings

• Yoon BR
• Kwon SH
• Oh JY
• Youn HC
• Oh JH

• KMID: 2418657
• DOI: http://doi.org/10.3348/jksr.2018.79.3.161

Abstract

A 63-year-old male patient was referred for venography of the thoracic venous system and multidetector computed tomography (CT) due to the unusual location of the left subclavian catheter tip. His venogram and CT images showed an absence of the left brachiocephalic vein (LBCV). Instead of through the LBCV, the usual venous circulation of neck and left upper limb was carried out by the engorged left superior intercostal vein (LSIV); this subsequently drained into the accessory hemiazygos vein and then the azygos vein that drains into the superior vena cava. Here, we report a rare case of an incidentally found absence of the LBCV with venous return through the LSIV in an adult patient, and we present a brief review of the relevant literature.

MeSH Terms

Adult*
Azygos Vein
Brachiocephalic Veins*
Cardiovascular Abnormalities
Catheters
Humans
Male
Middle Aged
Multidetector Computed Tomography
Neck
Phlebography*
Upper Extremity
Veins*
Vena Cava, Superior

Figure

• 

  Fig. 1 A 63-year-old man presenting incidentally found absence of the LBCV with venous return through the LSIV. Chest X-ray (A) showed the unusual location of the left central venous catheter tip at the left side of the thoracic vertebral bodies (arrows). Anteroposterior and lateral venographic images (B) and axial (C) three dimensional reconstruction computed tomography images (D) showing an absence of the LBCV with venous drainage into the LSIV, which subsequently drained into the accessory hemiazygos vein and the azygos vein, and finally into the SVC. aHAV = accessory hemiazygos vein, AV = azygos vein, LBCV = left brachiocephalic vein, LSIV = left superior intercostal vein, SVC = superior vena cava

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