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Retro-aortic brachiocephalic vein with azygous vein continuation: a rare vascular variant

Published online by Cambridge University Press:  15 March 2021

Arjun K. Mahendran Open the ORCID record for Arjun K. Mahendran [Opens in a new window]  and
Arun Chandran
Arjun K. Mahendran*
Affiliation:
UF Congenital Heart Center, Department of Pediatrics, 1600 SW Archer Rd, P.O. Box 100296, Gainesville, FL, 32610, USA
Arun Chandran
Affiliation:
UF Congenital Heart Center, Department of Pediatrics, 1600 SW Archer Rd, P.O. Box 100296, Gainesville, FL, 32610, USA
*
Author for correspondence: A. K. Mahendran, UF Congenital Heart Center, 1600 SW Archer Rd, P.O. Box 100296, Gainesville, FL, 32610, USA. Tel: +1 (352) 273-7771. E-mail: amahendran@ufl.edu
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Abstract

We present an infant with incidentally found retro-aortic left brachiocephalic vein draining directly into azygous vein. This rare vascular variant is asymptomatic but does have clinical implications with surgical and interventional procedures.

Keywords

Retro-aortic brachiocephalic veinvascular variantcongenital heart diseasecomputed tomography scan

Information

Type
Images in Congenital Cardiac Disease
Information
Cardiology in the Young , Volume 31 , Issue 6 , June 2021 , pp. 1015 - 1016
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

Case

An infant with a concern for vascular ring underwent a CT that demonstrated a right aortic arch with aberrant left subclavian artery. There was an incidental finding of a retro-aortic left brachiocephalic vein coursing through the posterior mediastinum, draining into the azygous vein close to its connection with the right superior vena cava (Figs 1 and 2a–b).

Figure 1.

Coronal CT image in venous phase. Contrast injection from the left hand delineating the LBV (red arrow) coursing rightward through the posterior mediastinum, draining into the azygous vein (yellow arrow).

Figure 2.

(a and b) Volume-rendered 3D image of retro-aortic brachiocephalic vein in posteroanterior and superoinferior orientation. LBV (red arrow) courses posteriorly to the descending aorta to drain into the azygous vein (yellow arrow), which drains into the superior vena cava (white arrow).

Discussion

Retro-aortic LBV is seen in 0.5–1% of all CHD. Different LBV variants (including sub-aortic) have been described, but retro-aortic LBV with azygous continuation is a rare vascular variant. Embryologically, it is likely caused by the improper persistence of the inferior transverse venous plexus between the cardinal veins, which is preceded by an abnormal aortic arch formation that prevents the typical anastomosis between the anterior cardinal veins. Reference İkidağ1 Although there are no compressive effects, pre-procedural recognition is vital for surgeries involving the posterior mediastinum to avoid injury. Furthermore, identification is important prior to placement of central venous lines or transvenous pacemaker leads.

Acknowledgements

None.

Financial support

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Conflict of interest

None.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards.

References

İkidağ, MA. Retroaortic course and Azygous continuation of an aberrant left brachiocephalic vein. Korean Circ J 2018; 48: 763–765. doi: 10.4070/kcj.2018.0092 CrossRefGoogle ScholarPubMed
Figure 0

Figure 1. Coronal CT image in venous phase. Contrast injection from the left hand delineating the LBV (red arrow) coursing rightward through the posterior mediastinum, draining into the azygous vein (yellow arrow).

Figure 1

Figure 2. (a and b) Volume-rendered 3D image of retro-aortic brachiocephalic vein in posteroanterior and superoinferior orientation. LBV (red arrow) courses posteriorly to the descending aorta to drain into the azygous vein (yellow arrow), which drains into the superior vena cava (white arrow).