open access

Vol 76, No 1 (2017)
ORIGINAL ARTICLES
Published online: 2016-05-24
Submitted: 2016-02-09
Accepted: 2016-04-25
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Anomalous left brachiocephalic vein: important vascular anomaly concomitant with congenital anomalies and heart diseases

S. Kahkouee, M. Sadr, E. Pedarzadeh, S. Fardin, A. Borhani, S. Gholami, G. Amjad
DOI: 10.5603/FM.a2016.0031
·
Pubmed: 27830886
·
Folia Morphol 2017;76(1):51-57.

open access

Vol 76, No 1 (2017)
ORIGINAL ARTICLES
Published online: 2016-05-24
Submitted: 2016-02-09
Accepted: 2016-04-25

Abstract

Background: Anomalous left brachiocephalic vein (ALBCV) is a rare and less known systemic venous anomaly. Infrequently, this vein takes an abnormal course and passes to the right behind or beneath the aortic arch to create the superior vena cava (SVC). Its incidence was reported much higher in patients with congenital heart disease especially in conotruncal and aortic arch anomalies. It could be misdiagnosed with normal or abnormal mediastinal structures. It also could make complication during surgeries or invasive strategies. Previously, this anatomical finding has been reported in case reports and there are just few studies evaluating these patients as a group to find other abnormalities

Materials and methods: We conducted a retrospective, multicentre study between 2008 and 2014 at three institutions. We reviewed thoracic computed tomography angiography of 1372 patients referred to these centres. The diagnosis of ALBCV was confirmed by an expert radiologist and the imagings were reassessed to identify new cases and concomitant anomalies. We analysed the imagings’ details and measured the prevalence of each anomaly.

Results: Among the 22 cases of ALBCV, 12 (54.5%) and 10 (45.4%) patients were males and females, respectively, with median age of 12.5 years. Tetralogy of Fallot (TOF) was considered as a most concomitant anomaly with ALBCV (54.5%). Two patients had associated atrial septal defect (ASD) and defined as pentalogy of Fallot. Right-sided aortic arc (RSAA) was detected in 12 (54.5%) patients; mirror image was found in 5 of them. Pure ventricular septal defect or pulmonary stenosis without TOF was recognised in 4 patients. Three cases had isolated overriding aorta (13.6%). In 3 patients, we could find patent ductus arteriosus (13.6%). In 2 (9%) patients, abdominal haemangioma was incidentally diagnosed. Aberrant left retrotracheal subclavian artery was detected in 1 (4.5%) patient. One patient only had isolated ALBCV (4.5%).

Conclusions: In our study, ALBCV was frequently seen in association with other congenital anomalies. mostly TOF and RSAA. In patients with pulmonary hypoplasia or aplasia, some parts of lung’s blood supply were provided by abnormal aorto-pulmonary connections. For a radiologist, it is important to differentiate this anomaly in cross-sectional imaging from persistent left SVC, partial anomalous pulmonary veins return and an enlarged lymph node. Detection of ALBCV could draw the attention to the more serious heart disease and in isolated forms prevented further evaluations.  

Abstract

Background: Anomalous left brachiocephalic vein (ALBCV) is a rare and less known systemic venous anomaly. Infrequently, this vein takes an abnormal course and passes to the right behind or beneath the aortic arch to create the superior vena cava (SVC). Its incidence was reported much higher in patients with congenital heart disease especially in conotruncal and aortic arch anomalies. It could be misdiagnosed with normal or abnormal mediastinal structures. It also could make complication during surgeries or invasive strategies. Previously, this anatomical finding has been reported in case reports and there are just few studies evaluating these patients as a group to find other abnormalities

Materials and methods: We conducted a retrospective, multicentre study between 2008 and 2014 at three institutions. We reviewed thoracic computed tomography angiography of 1372 patients referred to these centres. The diagnosis of ALBCV was confirmed by an expert radiologist and the imagings were reassessed to identify new cases and concomitant anomalies. We analysed the imagings’ details and measured the prevalence of each anomaly.

Results: Among the 22 cases of ALBCV, 12 (54.5%) and 10 (45.4%) patients were males and females, respectively, with median age of 12.5 years. Tetralogy of Fallot (TOF) was considered as a most concomitant anomaly with ALBCV (54.5%). Two patients had associated atrial septal defect (ASD) and defined as pentalogy of Fallot. Right-sided aortic arc (RSAA) was detected in 12 (54.5%) patients; mirror image was found in 5 of them. Pure ventricular septal defect or pulmonary stenosis without TOF was recognised in 4 patients. Three cases had isolated overriding aorta (13.6%). In 3 patients, we could find patent ductus arteriosus (13.6%). In 2 (9%) patients, abdominal haemangioma was incidentally diagnosed. Aberrant left retrotracheal subclavian artery was detected in 1 (4.5%) patient. One patient only had isolated ALBCV (4.5%).

Conclusions: In our study, ALBCV was frequently seen in association with other congenital anomalies. mostly TOF and RSAA. In patients with pulmonary hypoplasia or aplasia, some parts of lung’s blood supply were provided by abnormal aorto-pulmonary connections. For a radiologist, it is important to differentiate this anomaly in cross-sectional imaging from persistent left SVC, partial anomalous pulmonary veins return and an enlarged lymph node. Detection of ALBCV could draw the attention to the more serious heart disease and in isolated forms prevented further evaluations.  

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Keywords

anomalous left brachiocephalic vein, computed tomography angiography, anomaly

About this article
Title

Anomalous left brachiocephalic vein: important vascular anomaly concomitant with congenital anomalies and heart diseases

Journal

Folia Morphologica

Issue

Vol 76, No 1 (2017)

Pages

51-57

Published online

2016-05-24

DOI

10.5603/FM.a2016.0031

Pubmed

27830886

Bibliographic record

Folia Morphol 2017;76(1):51-57.

Keywords

anomalous left brachiocephalic vein
computed tomography angiography
anomaly

Authors

S. Kahkouee
M. Sadr
E. Pedarzadeh
S. Fardin
A. Borhani
S. Gholami
G. Amjad

References (19)
  1. Bartoli JM, Chagnaud C, Moulin G, et al. Pseudocoarctation of the aorta associated with retro-aortic left brachiocephalic vein: a case report. Surg Radiol Anat. 1990; 12(4): 307–309.
  2. Budhiraja V, Rastogi R. Unusual origin and potentially hazardous course of major blood vessels in neck. A clinically relevant rare case. Int J Anat Var. 2010; 3: 61–62.
  3. Chen SJ, Liu KL, Chen HY, et al. Anomalous brachiocephalic vein: CT, embryology, and clinical implications. AJR Am J Roentgenol. 2005; 184(4): 1235–1240.
  4. Choi JY, Jung MJ, Kim YH, et al. Anomalous subaortic position of the brachiocephalic vein (innominate vein): an echocardiographic study. Br Heart J. 1990; 64(6): 385–387.
  5. Clemente CD. The veins. Gray’s anatomy. 30th American Ed. Lea Febiger, Philadelphia, 1985; pp. 788–865.
  6. Curtil A, Tronc F, Champsaur G, et al. The left retro-aortic brachiocephalic vein: morphologic data and diagnostic ultrasound in 27 cases. Surg Radiol Anat. 1999; 21(4): 251–254.
  7. Gerlis LM, Ho SY. Anomalous subaortic position of the brachiocephalic (innominate) vein: a review of published reports and report of three new cases. Br Heart J. 1989; 61(6): 540–545.
  8. Ito M, Kikuchi S, Hachiro Y, et al. Anomalous subaortic position of the brachiocephalic vein associated with Tetralogy of Fallot. Ann Thorac Cardiovasc Surg. 2001; 7(2): 106–108.
  9. Kershner L. Morphologie der vena cava inferior. Anat Anz. 1888; 3: 808–823.
  10. Kulkarni S, Jain S, Kasar P, et al. Retroaortic left innominate vein - Incidence, association with congenital heart defects, embryology, and clinical significance. Ann Pediatr Cardiol. 2008; 1(2): 139–141.
  11. Mill MR, Wilcox BR, Detterbeck FC, et al. Anomalous course of the left brachiocephalic vein. Ann Thorac Surg. 1993; 55(3): 600–602.
  12. Minami M, Noda M, Kawauchi N, et al. Postaortic left innominate vein: radiological assessment and pathogenesis. Clin Radiol. 1993; 48(1): 52–56.
  13. Morhy Borges Leal S, Andrade JL, de Souza M, et al. Anomalous subaortic course of the left brachiocephalic (innominate) vein: echocardiographic diagnosis and report of an unusual association. Cardiol Young. 2002; 12(2): 159–163.
  14. Nagashima M, Shikata F, Okamura T, et al. Anomalous subaortic left brachiocephalic vein in surgical cases and literature review. Clin Anat. 2010; 23(8): 950–955.
  15. Nakamura R, Yoshihisa I, Iwasaki K, et al. Left anomalous brachiocephalic vein in a patient with right lung cancer. Ann Thorac Surg. 2013; 96(1): 307–309.
  16. Park C, Kim K, Park M, et al. Subaortic Left Brachiocephalic Vein. Korean Circulation J. 2006; 36(8): 605.
  17. Srinivasan S, Kannivelu A, Ali SZ, et al. Isolated retroaortic left innominate vein in an adult without cardiac or aortic anomalies. Indian J Radiol Imaging. 2013; 23(4): 308–309.
  18. Townsend MD, Jonas RA, Moskowitz WB. Congenital communication of a retroaortic innominate vein with both the left and right atria in the presence of a normal coronary sinus. Pediatr Cardiol. 2008; 29(4): 823–826.
  19. Yilmaz M, Sargon MF, Dogan OF, et al. A very rare anatomic variation of the left brachiocephalic vein: left retro-aortic brachiocephalic vein with tetralogy of Fallot. Surg Radiol Anat. 2003; 25(2): 158–160.

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