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Venous Anomalies of the Thorax

¹ All authors: Department of Radiology, Loyola University Medical Center, 2160 S First Ave., Maywood, IL 60153.

View larger version (110K): [in a new window]   Fig. 1. —54-year-old man with normal heart and duplicated superior vena cava (SVC). Chest radiograph shows pulmonary artery catheter (arrows) in left SVC extending through coronary sinus to right atrium.

View larger version (124K): [in a new window]   Fig. 2. —50-year-old woman with duplicated superior vena cava (SVC). Series of CT scans shows course of left SVC (short arrows) along left side of mediastinum. SVC drains into characteristically enlarged coronary sinus. Right SVC (arrowheads) is faintly opacified. Note left superior pulmonary vein (long arrow) and mediastinal lymphadenopathy caused by lymphoma.

View larger version (93K): [in a new window]   Fig. 3A. —35-year-old woman with coronary sinus type of atrial septal defect with left superior vena cava (SVC) draining into left atrium. Gradient-echo MR image obtained at level of pulmonary trunk shows right (arrowheads) and left (white arrow) SVC. Left superior pulmonary vein (black arrow) is also shown.

View larger version (104K): [in a new window]   Fig. 3B. —35-year-old woman with coronary sinus type of atrial septal defect with left superior vena cava (SVC) draining into left atrium. Gradient-echo MR image obtained caudad to A shows that left SVC has now joined left atrium (LA). Note left atrial appendage (arrow). Drainage to left atrium is almost always associated with congenital heart disease.

View larger version (128K): [in a new window]   Fig. 4A. —29-year-old man with left but no right superior vena cava (SVC). Chest radiograph shows abnormally prominent ascending aorta. Patient had no cardiovascular disease.

View larger version (165K): [in a new window]   Fig. 5A. —9-year-old boy with superior vena cava (SVC) aneurysm. (Courtesy of Donaldson J, Chicago, IL) Chest radiograph shows widened mediastinum.

View larger version (67K): [in a new window]   Fig. 5B. —9-year-old boy with superior vena cava (SVC) aneurysm. (Courtesy of Donaldson J, Chicago, IL) CT scan shows markedly dilated SVC (arrowhead). Patient also had cystic hygroma of right axilla (arrow) and neck.

View larger version (134K): [in a new window]   Fig. 6. —Azygos anatomy on venogram of 60-year-old woman with inferior vena cava (IVC) stricture. Ascending lumbar veins drain to azygos (short black arrows) and hemiazygos vein (long black arrows) in chest. Hemiazygos vein joins azygos vein (white arrowhead) at T9. Azygos vein continues cephalad and forms azygos arch (black arrowheads) draining into superior vena cava. Note small accessory hemiazygos vein (white arrow) and stenosis of IVC (c).

View larger version (46K): [in a new window]   Fig. 4B. —29-year-old man with left but no right superior vena cava (SVC). CT scan shows single left SVC (arrow). Aorta is normal. Ascending aorta is prominent on radiograph because right SVC is absent. Thus, right upper lobe outlines ascending aorta.

View larger version (137K): [in a new window]   Fig. 7A. —42-year-old man with absent azygos vein. Chest radiograph shows prominent left superior intercostal vein (arrow) simulating mediastinal abnormality. Note absent en face azygos arch at right tracheobronchial junction.

View larger version (75K): [in a new window]   Fig. 7B. —42-year-old man with absent azygos vein. CT scan shows absence of azygos arch and enlarged left superior intercostal vein (arrow).

View larger version (120K): [in a new window]   Fig. 8A. —51-year-old man with azygos lobe. Chest radiograph shows azygos vein (arrow) and fissure (arrowheads) bounding azygos lobe.

View larger version (119K): [in a new window]   Fig. 8B. —51-year-old man with azygos lobe. CT scan shows displaced azygos vein (arrowheads) draining into right brachiocephalic vein (arrow) and separating azygos lobe from right upper lobe.

View larger version (137K): [in a new window]   Fig. 9. —28-year-old man with hemiazygos lobe. Chest radiograph shows pleura (arrows) bounding hemiazygos lobe.

View larger version (147K): [in a new window]   Fig. 10. —32-year-old man with azygos continuation of inferior vena cava. Chest radiograph shows large azygos vein (arrowheads) extending to dilated azygos arch (arrow) at right tracheobronchial junction. Patient had osteosarcoma of femur, and chest radiograph shows findings suspicious for enlarged azygos lymph node.

View larger version (140K): [in a new window]   Fig. 11. —24-year-old woman with azygos lobe and azygos continuation of inferior vena cava. Chest radiograph shows large azygos vein (arrows) extending to azygos fissure.

View larger version (94K): [in a new window]   Fig. 12A. —53-year-old man with polysplenia, congenital heart disease, and azygos continuation. CT scan shows large azygos arch (arrows).

View larger version (112K): [in a new window]   Fig. 12B. —53-year-old man with polysplenia, congenital heart disease, and azygos continuation. CT scan shows large azygos vein (arrow) near diaphragm. CA = common atrium.

View larger version (151K): [in a new window]   Fig. 12C. —53-year-old man with polysplenia, congenital heart disease, and azygos continuation. CT scan of upper abdomen shows multiple spleens (s).

View larger version (103K): [in a new window]   Fig. 13A. —32-year-old man with polysplenia and situs inversus and hemiazygos continuation of inferior vena cava. CT scan shows right and left pulmonary arteries ventral to main bronchi, indicating bilateral left lung anatomy (left isomerism). Note duplicated superior vena cava (arrows), right descending aorta (A), and dilated hemiazygos vein (arrowhead).

View larger version (141K): [in a new window]   Fig. 13B. —32-year-old man with polysplenia and situs inversus and hemiazygos continuation of inferior vena cava. CT scan shows liver in left upper quadrant. Note two of several right upper quadrant spleens (s).

View larger version (92K): [in a new window]   Fig. 14A. —36-year-old woman with complex congenital heart disease and hemiazygos continuation of inferior vena cava draining into left superior vena cava (SVC). CT scan shows dilated left superior intercostal vein (arrowheads) arching anteriorly to join left SVC.

View larger version (106K): [in a new window]   Fig. 14B. —36-year-old woman with complex congenital heart disease and hemiazygos continuation of inferior vena cava draining into left superior vena cava (SVC). CT scan obtained at level of right pulmonary artery shows dilated left SVC (long arrow) and accessory hemiazygos vein (arrowhead). Note small right SVC (short arrow) and right descending aorta (A).

View larger version (76K): [in a new window]   Fig. 15. —55-year-old man with normal pulmonary veins. Posterior view of CT volume-rendered image shows bilateral superior and inferior veins entering left atrium.

View larger version (73K): [in a new window]   Fig. 16A. —Pulmonary vein variants. Posterior view of CT volume-rendered image shows three right pulmonary veins of 54-year-old man. Third vein (arrows) drains right middle lobe.

View larger version (100K): [in a new window]   Fig. 16B. —Pulmonary vein variants. Posterior view of CT volume-rendered image shows single left pulmonary vein (arrow) draining left lung of 46-year-old man. Note stenosis (arrowhead) of superior right pulmonary vein.

View larger version (113K): [in a new window]   Fig. 17. —64-year-old man with partial anomalous pulmonary venous return to azygos vein. Series of CT scans shows anomalous right upper lobe vein (arrows) draining into dilated azygos arch (AZ).

View larger version (133K): [in a new window]   Fig. 18A. —48-year-old woman with partial anomalous pulmonary venous return (PAPVR) to superior vena cava (SVC) associated with sinus venosus atrial septal defect. Gradient-echo MR image shows anomalous right upper lobe pulmonary veins (arrows) draining into SVC (S).

View larger version (136K): [in a new window]   Fig. 18B. —48-year-old woman with partial anomalous pulmonary venous return (PAPVR) to superior vena cava (SVC) associated with sinus venosus atrial septal defect. T1-weighted MR image shows sinus venosus atrial septal defect (arrow). This uncommon type of atrial septal defect is often associated with PAPVR.

View larger version (113K): [in a new window]   Fig. 19A. —21-year-old woman with scimitar syndrome. Chest radiograph shows large curved vein (arrows) extending to diaphragm. Note relatively small right lung with decreased pulmonary vascularity.

View larger version (113K): [in a new window]   Fig. 19B. —21-year-old woman with scimitar syndrome. CT scan shows anomalous vein joining inferior vena cava (arrow) below diaphragm.

View larger version (124K): [in a new window]   Fig. 20. —55-year-old woman with partial anomalous pulmonary venous return from left upper lobe. Unusual position of left jugular IV catheter (arrows) on radiograph led to venogram with opacification of anomalous left pulmonary vein draining into right superior vena cava (S) via vertical vein (white arrowheads) and left brachiocephalic vein (black arrowheads).

View larger version (135K): [in a new window]   Fig. 21A. —66-year-old woman with partial anomalous pulmonary venous return (PAPVR) from left upper lobe. Chest radiograph shows sharply defined paraaortic opacity (arrows) that represents vertical vein connecting anomalous left upper lobe pulmonary vein to brachiocephalic vein.

View larger version (96K): [in a new window]   Fig. 21B. —66-year-old woman with partial anomalous pulmonary venous return (PAPVR) from left upper lobe. Series of CT scans show left upper lobe PAPVR (long arrows) draining via vertical vein (short arrows) into left brachiocephalic vein (arrowhead).

View larger version (122K): [in a new window]   Fig. 22. —3-month-old cyanotic boy with total anomalous pulmonary venous return and "snowman" sign. Chest radiograph shows rounded superior mediastinum. Head of snowman is formed by large left vertical vein and large right superior vena cava. Body of snowman is heart.

View larger version (133K): [in a new window]   Fig. 23A. —5-month-old boy with pulmonary atresia, atrioventricular canal, and azygos continuation of inferior vena cava and total anomalous pulmonary venous return draining into superior vena cava (SVC). T1-weighted MR image shows left pulmonary vein (arrow) draining into anomalous retrocardiac vein (v). Note large azygos vein (arrowhead) caused by azygos continuation. EN = large endocardial cushion defect, A = aorta.

View larger version (126K): [in a new window]   Fig. 23B. —5-month-old boy with pulmonary atresia, atrioventricular canal, and azygos continuation of inferior vena cava and total anomalous pulmonary venous return draining into superior vena cava (SVC). Sagittal T1-weighted MR image shows distal anomalous retrocardiac vein (v) that receives all pulmonary veins and arches to join SVC (long arrows). Note enlarged azygos arch (short arrows).

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