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Imaging of the Brachiocephalic Vein

¹ Department of Radiology, Division of General Radiology, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University, College of Medicine, 123 Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung, 833, Taiwan.
² Department of Cardiovascular and Thoracic Surgery, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung, Taiwan.
³ Department of Pediatric Cardiology, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung, Taiwan.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Sketches show four stages of embryologic development of brachiocephalic and internal jugular veins and superior vena cava (SVC). Starting with 4-mm embryo, bilateral precardinal (PCV) and postcardinal (PoCV) veins join to form common cardinal veins (CCV).

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Sketches show four stages of embryologic development of brachiocephalic and internal jugular veins and superior vena cava (SVC). In 10-mm embryo, precardinal anastomosis (PCA) has developed between bilateral PCV.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Sketches show four stages of embryologic development of brachiocephalic and internal jugular veins and superior vena cava (SVC). In 17-mm embryo, normal left brachiocephalic vein (LBCV) has developed from persistence of right CCV and PCA and regression of middle and lower portions of left CCV. Internal jugular veins (IJV) have developed from upper parts of PCV. Subclavian veins (SV) have developed as tributaries of CCV.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Sketches show four stages of embryologic development of brachiocephalic and internal jugular veins and superior vena cava (SVC). In 24-mm embryo, SVC has developed from right CCV joining heart and hepatocardiac vein, which eventually develop as hepatic segment of inferior vena cava. BCVs = brachiocephalic veins.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A — 74-year-old man with asymptomatic anomalous subaortic left brachiocephalic vein. Subvolume oblique axial reconstruction (A) and curved planar reconstruction (B) chest CT scans show anomalous subaortic course of left brachiocephalic vein (arrows) joining lower third of superior vena cava, which is formed when there is abnormal regression of superior precardinal anastomosis and preservation of distal part of left common cardinal vein and lower precardinal anastomosis.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B — 74-year-old man with asymptomatic anomalous subaortic left brachiocephalic vein. Subvolume oblique axial reconstruction (A) and curved planar reconstruction (B) chest CT scans show anomalous subaortic course of left brachiocephalic vein (arrows) joining lower third of superior vena cava, which is formed when there is abnormal regression of superior precardinal anastomosis and preservation of distal part of left common cardinal vein and lower precardinal anastomosis.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —23-year-old man with situs ambiguus, transposition of great arteries, common atrium and single ventricle, pulmonary atresia and right patent ductus arteriosus, and functional left Blalock-Taussig shunt, double superior vena cava, and hypoplastic left brachiocephalic vein. Coronal reconstruction chest CT scan shows double superior vena cava (open arrows) and hypoplastic left brachiocephalic vein (solid arrows), which is formed by regression of lower precardinal anastomosis with total preservation of left common cardinal vein and superior precardinal anastomosis.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —11-year-old boy with coarctation of aorta, bicuspid aortic valve, double superior vena cava, and agenesis of left brachiocephalic vein. Axial T1-weighted (A) and collapsed gadolinium-enhanced (B) MR angiograms show presence of double superior vena cava (arrows) and agenesis of left brachiocephalic vein, which is formed by preservation of left common cardinal vein with obliteration of whole precardinal anastomosis.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —11-year-old boy with coarctation of aorta, bicuspid aortic valve, double superior vena cava, and agenesis of left brachiocephalic vein. Axial T1-weighted (A) and collapsed gadolinium-enhanced (B) MR angiograms show presence of double superior vena cava (arrows) and agenesis of left brachiocephalic vein, which is formed by preservation of left common cardinal vein with obliteration of whole precardinal anastomosis.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —66-year-old woman with colon cancer and insertion of totally implantable venous device. Supine chest radiograph shows venous device catheter (arrows) placed along left side of mediastinum indicating insertion to left superior vena cava with distal part through coronary sinus to right atrium.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —17-year-old boy with chest tightness due to anterior mediastinal seminoma. Axial (A) and coronal (B) enhanced T1-weighted MR images show inhomogeneously enhanced anterior mediastinal tumor (solid arrows) with invasion of left brachiocephalic vein and intraluminal spread of tumor to superior vena cava (open arrows).

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —17-year-old boy with chest tightness due to anterior mediastinal seminoma. Axial (A) and coronal (B) enhanced T1-weighted MR images show inhomogeneously enhanced anterior mediastinal tumor (solid arrows) with invasion of left brachiocephalic vein and intraluminal spread of tumor to superior vena cava (open arrows).

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —58-year-old man with rapidly growing right axillary rhabdomyosarcoma. Coronal T1-weighted MR image shows large right axillary mass and central tumor extension (arrows) through right subclavian vein and brachiocephalic vein to superior vena cava.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —50-year-old man with right upper lobe squamous cell carcinoma. Axial (A) and coronal (B) CT scans show right upper lobe lung tumor (open arrows) with obstructive atelectasis and invasion of adjacent mediastinum with encasement of superior vena cava. Anomalous subaortic left brachiocephalic vein (solid arrow) mimics enlarged lymph node in A.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —50-year-old man with right upper lobe squamous cell carcinoma. Axial (A) and coronal (B) CT scans show right upper lobe lung tumor (open arrows) with obstructive atelectasis and invasion of adjacent mediastinum with encasement of superior vena cava. Anomalous subaortic left brachiocephalic vein (solid arrow) mimics enlarged lymph node in A.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —57-year-old man with chest pain 1 hour after blunt chest trauma in motor vehicle crash. Unenhanced axial CT scan shows cordlike hyperdense hematoma along course of left brachiocephalic vein (arrows).

View larger version (92K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —57-year-old man with chest pain 1 hour after blunt chest trauma in motor vehicle crash. Contrast-enhanced axial CT scan shows encasement of left brachiocephalic vein (open arrow) by cordlike perivenous hematoma (solid arrows).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —57-year-old man with chest pain 1 hour after blunt chest trauma in motor vehicle crash. Follow-up CT scan 3 months after conservative treatment shows marked regression of perivenous hematoma (arrows).

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —70-year-old woman with asymptomatic mediastinal mass incidentally found on chest radiograph. Erect chest radiograph shows no mediastinal mass.

View larger version (151K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —70-year-old woman with asymptomatic mediastinal mass incidentally found on chest radiograph. Supine chest radiograph shows large left upper mediastinal mass (arrow).

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C —70-year-old woman with asymptomatic mediastinal mass incidentally found on chest radiograph. Volume-rendered display of chest CT angiogram shows large saccular aneurysm (open arrow) originating from left brachiocephalic vein (solid arrow).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —69-year-old woman with end-stage renal disease and swelling of left upper extremity 11 months after establishment of left brachiocephalic dialysis fistula. Oblique axial CT scan shows dilated left brachiocephalic vein with thrombus (solid arrows) due to severe brachiocephalic vein stenosis (open arrow) immediately proximal to superior vena cava.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —75-year-old man admitted because of progressive right facial and right upper extremity swelling. Surface-shaded display of chest CT angiogram shows multiple engorged superficial veins (arrows) in right side of face, upper part of chest, and upper extremity.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —75-year-old man admitted because of progressive right facial and right upper extremity swelling. Oblique coronal reconstruction CT scan shows severe stenosis of right brachiocephalic vein (arrow).

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A —87-year-old woman with shock after placement of central venous catheter. Chest radiograph shows abnormal loop of central venous catheter (arrows) in right upper part of chest and adjacent massive accumulation of pleural fluid.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B —87-year-old woman with shock after placement of central venous catheter. Enhanced axial CT scan shows penetration of catheter (arrow) through right brachiocephalic vein and massive right hemothorax.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —80-year-old woman with progressive right upper extremity swelling 21 weeks after insertion of dialysis double catheter through right internal jugular vein. Oblique axial (A) and coronal (B) CT scans show site of insertion of dialysis double catheter (solid arrows) to right brachiocephalic vein with thrombosis (open arrows) of right subclavian vein.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —80-year-old woman with progressive right upper extremity swelling 21 weeks after insertion of dialysis double catheter through right internal jugular vein. Oblique axial (A) and coronal (B) CT scans show site of insertion of dialysis double catheter (solid arrows) to right brachiocephalic vein with thrombosis (open arrows) of right subclavian vein.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15A —60-year-old man with rectal cancer and implanted venous device for chemotherapy. Photograph shows withdrawal of chylous fluid (arrow) from implanted port.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15B —60-year-old man with rectal cancer and implanted venous device for chemotherapy. Venogram with contrast injection through implanted port shows marked stenosis (arrows) of central part of left brachiocephalic vein.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15C —60-year-old man with rectal cancer and implanted venous device for chemotherapy. Left upper extremity venogram shows simultaneous occlusion of left subclavian vein and prominent collateral veins in left shoulder and left neck regions (arrows).

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