대한흉부영상의학회 Weekly Chest Cases

Case No : 534 Date 2008-01-21

Courtesy of Hyun Kyung Lim, MD, Yu Mi Jang, MD, Eun Jin Chae, MD, Kyung-Hyun Do, MD. / Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Age/Sex 71 / M
Chief ComplaintUnusual course of hemodialysis catheter. Known hospital acquired pneumonia after RUL lobectomy for lung cancer.

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Anomalous left brachiocephalic vein
Radiologic Findings: Posteroanterior chest radiograph show an abnormal course of left central venous catheter. CT images reveal anomalous, left brachiocephalic vein (asterisk) located between ascending aorta and trachea as it crosses midline, passing below aortic arch with drainage into superior vena cava at level slightly lower than entry of azygos arch (Figure 2)
Brief Review: The reported prevalence of an anomalous brachiocephalic vein is 0.2-1.7 %.
Presence of a right-sided aortic arch and underdeveloped pulmonary artery are significantly more common in patients with an anomalous brachiocephalic vein than in those without.
The exact embryogenesis of this anomaly remains unknown.
Pattern definitions are as described by Takada et al. Ten anomalous brachiocephalic vein subpatterns were recognized on the basis of the relationship between the anomalous brachiocephalic vein and adjacent vessel anomalies. Most of cases were pattern b, which incorporated anomalous brachiocephalic veins crossing the midline beneath the aortic arch, above the pulmonary artery, and in front of a patent ductal arteriosus or ligamentum arteriosus.
To the radiologist, the descending portion of an anomalous brachiocephalic vein must be differentiated from a persistent left superior vena cava, an ascending vertical vein in a total anomalous pulmonary venous connection, and a left partial anomalous pulmonary venous return. The middle portion needs to be differentiated from the central pulmonary artery. The retroaortic crossing segment of the anomalous brachiocephalic vein may be misinterpreted on unenhanced CT as an enlarged lymph node, an elevated right pulmonary artery in patients with hypoplastic or atretic central pulmonary arteries, or an early branching right upper lobe pulmonary artery on cross-sectional echocardiography. Carefully tracing this vascular channel through sequential images is the key to differentiation.
The preoperative diagnosis of this anomaly is important when any cardio-vascular intervention, central line procedures are to be performed.
References: 1. Chen SJ, Liu KL, Chen HY, Chiu IS, Lee WJ, Wu MH, Li YW, Lue HC. Anomalous brachiocephalic vein: CT, embryology, and clinical implications. AJR Am J Roentgenol. 2005 Apr;184(4):1235-40.
2. Takada Y, Narimatsu A, Kohno A, et al. Anomalous left brachiocephalic vein: CT findings. J Comput Assist Tomo 1992;16:893 -896
Keywords: Vascular, Congenital, Anomaly,

No. of Applicants : 53

▶ Correct Answer : 29/53, 54.7%

- Shiga University of Medical, Japan Norihisa Nitta
- Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Osaka University, Japan Osamu Honda
- Gimpo Woori Hospital, Korea Son Youl Lee
- GMCH Chandigarh, India Sonali Jain
- Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
- Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
- Chonnam National University Hospital, Korea Song Choi
- IRSA, La Rochelle, France Denis Chabassiere
- Az. Osped. Santa Maria - Terni, Italy Angelo Carloni
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- China Medical University, Taiwan Jun-Jun Yeh
- Dongguk University International Hospital, Korea Hee Seok Choi
- Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
- Severance Hospital, Yonsei University College of Medicine, Korea Ji Youn Kim
- CHU de Poitiers, France Paul Ardilouze
- Annecy, France Gilles Genin
- Saga University, Japan Ryoko Egashira
- Yonsei University college of medicine Severance hospital, Korea Hua Sun Kim
- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
- Good gang-an hospital, Korea Kyung Hwa Jung
- IRSA La Rochelle, France Jean-Luc BIGOT
- Nassau, Bahamas Nitin Singh
- Armidale Radiology, Australia Saurabh Khandelwal
- Pittwater Radiology, Australia Julie Arora
- Aims, New Delhi, India Ashish Gupta
- Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
- Max Hospital, New Delhi, India Vickrant Malhotra

▶ Correct Answer as Differential Diagnosis : 1/53, 1.9%

- CHU Grenoble, France Bing Fabrice

▶ Semi-Correct Answer : 5/53, 9.4%

- Medinova Diagnostics, Bheemavaram, AP., India Harsha Vardhan
- Bollineni Hospital, Nellore, AP. India CH. Madhusudhan
- National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
- Nour EL Islam Radiology Center, Aexandria, Egypt Sayed Moussa
- CHRU Lille hopital calmette, France Toledano Manuel

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 534 Date 2008-01-21

Discussion

No. of Applicants : 53