CTICasesSVC Obstruction with Levoatrial Cardinal Vein Remnant Collateral
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Imaging findings
Computed tomography angiography reveals severe narrowing and occlusion of the superior vena cava and left brachiocephalic vein. A large anomalous venous collateral channel arises from the left innominate vein, courses posteriorly to the pulmonary artery, and directly anastomoses with the left inferior pulmonary vein, draining systemic venous blood directly into the left atrium.
Key takeaways
In the setting of chronic superior vena cava or brachiocephalic venous obstruction, embryonic venous remnants such as the levoatrial cardinal vein can recruit and dilate to serve as a major collateral pathway. Because this pathway connects a systemic vein directly to a pulmonary vein, it results in a systemic-to-pulmonary venous shunt (right-to-left shunt) and may require surgical or endovascular intervention.
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