Aberrant Left Brachiocephalic Vein versus Persistent Left Superior Vena Cava without Bridging Vein in Adults: Evaluation on Computed Tomography

Abstract

Objective: Persistent left superior vena cava without bringing vein (PLSVC w/o BV) is a common thoracic venous anomaly, while aberrant left brachiocephalic vein (ALBCV) is an uncommon condition. We compared the incidences of the two venous anomalies and assessed congenital cardiovascular diseases (CCDs) in adults using computed tomography (CT).Materials and Methods: We reviewed the recorded reports or CT images of 49,494 adults for PLSVC w/o BV and ALBCV in two hospitals. We determined incidences of two venous anomalies and the rate of associated CCDs.Results: 76 PLSVCs w/o BV and 27 ALBCVs were found. The incidence of PLSVC w/o BV was 0.15% and the incidence of ALBCV was 0.055%. PLSVC w/o BV had higher incidence than ALBCV (p<0.001). Four PLSVCs w/o BV and one ALBCV were associated with congenital heart diseases. Two PLSVCs w/o BV and four ALBCVs were associated with congenital aortic arch anomaly (CAAA). ALBCV had higher incidence of associated CAAA than PLSVC w/o BV (P=0.02).Conclusion: The incidence of ALBCV was <50% that of PLSVC w/o BV. The two venous anomalies found on CT during adulthood were rarely associated with CCDs.

Persistent left superior vena cava: clinical importance and differential diagnoses

“…Generally, the left common CV and the caudal part of the left superior CV will regress. If these veins do not regress, then they will persist as PLSVC [2,3,[8][9][10][11].…”

“…Generally, the left common CV and the caudal part of the left superior CV will regress. If these veins do not regress, then they will persist as PLSVC [ 2 , 3 , 8 – 11 ]. The detailed schematic anatomy of the developmental stages of the primitive venous system is shown in Fig.…”

Dilated Accessory Hemiazygos Vein Mimicking Aortic Dissection in Setting of Absent Left Brachiocephalic Vein

“…The left fourth to seventh intercostal veins drain into the accessory hemiazygos system. The accessory hemiazygos vein either drains superiorly to the left superior intercostal vein (LSIV) and into the left brachiocephalic or merges with the right-sided azygos vein at the level of T7-T8 [ 10 ]. In our patient, CT angiography revealed the absence of the left brachiocephalic vein with severe stenosis of the left internal jugular and subclavian vein, which resulted in the dilation of the LSIV and subsequent dilation of the accessory hemiazygos vein ( Figure 8 ).…”

The gap between the aorta and the superior vena cava: A sonographic sign of persistent left superior vena cava and associated abnormalities

“…Persistent left superior vena cava (SVC) or bilateral SVC is the most common anatomical variant in the thoracic venous system . In the general population, the estimated prevalence ranges between 0.3% and 0.5%, whereas the association in patients with congenital heart disease is higher and between 4% and 8% . More than one in five newborns (21.3%) diagnosed with coarctation of the aorta present with bilateral SVC .…”

“…In the four‐chamber view, it appears as a “bleb” inside the left atrium, because it usually drains into the coronary sinus leading to its dilatation . A failure of involution of the left anterior cardinal vein results in a persistent left SVC, in which case the venous drainage of the upper body occurs through both left and right SVC . The left brachiocephalic vein that usually crosses horizontally in the upper mediastinum anteriorly to the three branches of the aortic arch and finally empties into the right brachiocephalic vein is often missing .…”