CTICasesAbsent Left Brachiocephalic Vein with Persistent Left Superior Intercostal Vein
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Imaging findings
Contrast-enhanced CT chest shows congenital absence of the left brachiocephalic (innominate) vein. Left upper extremity venous outflow is instead redirected via a dilated left superior intercostal vein, which courses adjacent to the aortic arch (forming a prominent "aortic nipple") and flows posteriorly into the accessory hemiazygos vein to drain into the azygos-superior vena cava system.
Key takeaways
Congenital absence of the left brachiocephalic vein is a rare vascular anomaly that occurs when the transverse embryological venous anastomosis fails to form. Venous drainage from the left head and arm must find alternative pathways, most commonly through the left superior intercostal vein, which should not be mistaken for a mass, dissection, or persistent left superior vena cava on imaging.
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