Problem in diagnostic imaging: Mediastinal venous anomalies

An extremely rare reason for failure of left sided pacemaker implantation

We reported a case of isolated anomaly of the left brachiocephalic vein which is diagnosed during a permanent pacemaker implantation. It is a very rare anomaly and makes the left sided pacemaker implantation impossible.

Simultaneous occurrence of a thyromediastinal muscle, a truncus bicaroticobrachialis, and a left superior vena cava

A case is presented of a combination of anatomical anomalies found in a 67-year-old female cadaver during routine dissection by medical students. They include a thyromediastinal muscle, a truncus bicaroticobrachialis, and a left superior vena cava, with complete absence of the right superior vena cava, but with a normal azygos vein opening into the right atrium at the expected site of entry of the superior vena cava. No associated congenital cardiac malformations were found. Clinical implications include the difficulty of heart catheterization through the subclavian veins and misleading images on CT or MRI scans, where the azygos vein could be mistaken for a right superior vena cava.

Multi-detector row and volume-rendered CT of the normal and accessory flow pathways of the thoracic systemic and pulmonary veins

Multi-detector row computed tomography (CT) and volume rendering can be used as an interpretive aid to present the systemic and pulmonary venous anatomy of the thorax. Both of these venous systems are routinely imaged in clinical practice and are important in interpretation of diagnostic images in health and disease. Multi-detector row CT and three-dimensional volume rendering provide high-quality near-isotropic data (ie, the longitudinal resolution approximates the in-plane resolution). The data sets allow tailored postprocessing to produce images optimized for these vessels, which are often not fully appreciated at planar axial imaging alone. Venous structures of the thorax that can be demonstrated with multi-detector row CT and volume rendering include the jugular veins; the subclavian and brachiocephalic veins; the internal and lateral thoracic veins; the superior and inferior venae cavae; the coronary sinus, the cardiac and pericardiophrenic veins, and vein grafts; the azygos, hemiazygos, and accessory hemiazygos veins; the intercostal veins; the pulmonary veins; and other thoracic veins.