CTICasesCircumaortic (Retroaortic) Left Brachiocephalic Vein
Imaging findings
On a contrast-enhanced chest CT obtained for another indication, the left brachiocephalic vein was narrowed where it crossed between the great vessels and a prominent manubrium, but a second, vertically oriented vessel was seen dipping inferiorly, passing beneath the aortic arch, and draining into the superior vena cava rather than emptying superiorly or into a pulmonary vein.
Key takeaways
A vertically oriented vessel near the left brachiocephalic vein that drains inferiorly, beneath the aortic arch, into the SVC represents a circumaortic (retroaortic) left brachiocephalic vein, a patent embryologic venous remnant distinct from a persistent left SVC (which drains via the coronary sinus) or anomalous pulmonary venous drainage (which flows superiorly). Recognizing this variant matters when planning central venous or PICC line placement, since a catheter will take an unusual, circuitous course through an otherwise normal-caliber vessel.
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