Unique retroinnominate course of the left brachiocephalic vein

Description  

A 4-year-old girl diagnosed with tetralogy of Fallot on transthoracic echocardiogram, was referred for a CT angiography (CTA) for preoperative anatomical assessment of the primary cardiac defect and associated cardiovascular anomalies. Review of CTA images revealed a unique anomalous course of the left brachiocephalic vein (*) where it was seen crossing the midline above the arch, anterior to the left common carotid artery (LCCA) and left subclavian artery (LSCA) but coursing posterior to the innominate artery, before joining the right brachiocephalic vein (RBCV) to form the right superior vena cava (RSVC) (figure 1A–D).

Figure 1

Volume rendered and axial maximum intensity projection images of CT angiography  (A–D) depicts the left brachiocephalic vein (*) traversing anterior to the left subclavian artery and left common carotid artery and posterior to the innominate artery, before joining the right brachiocephalic vein. LCCA, left common carotid artery; LSCA, left subclavian artery; RBCV, right...

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