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

Bo Ra Yoon; Se Hwan Kwon; Ji Young Oh; Hyo-Chul Youn; Joo Hyeong Oh

doi:10.3348/jksr.2018.79.3.161

Journal List > J Korean Soc Radiol > v.79(3) > 1099985

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Yoon, Kwon, Oh, Youn, and Oh: 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

Case Report

J Korean Soc Radiol 2018;79(3):161-165.

Published online: 19 January 2018

DOI: https://doi.org/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

Bo Ra Yoon, MD¹, Se Hwan Kwon, MD^1,, Ji Young Oh, MD², Hyo-Chul Youn, MD³, Joo Hyeong Oh, MD¹

¹Department of Radiology, Seoul, Korea

²Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea

³Department of Cardiothoracic Surgery, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, Korea

^∗Corresponding author: Se Hwan Kwon, MD Department of Radiology, Kyung Hee Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea. Tel. 82-2-958-8622 Fax. 82-2-968-0787 E-mail:kwon98@khu.ac.kr

Received 3 November 2017 Revised 10 January 2018 Accepted 28 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Cardiovascular Abnormalities, Brachiocephalic Veins, Multidetector Computed Tomography

REFERENCES

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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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