Postaortic left brachiocephalic vein in an adult patient with right upper lung cancer

A 51-year old man underwent surgery for right upper lobe lung cancer. Computed tomography and 3D computed tomography (Fig. 1 ) showed rare displacement of the left brachiocephalic vein (crossing beneath the aortic arch). As similar findings were noted intraoperatively (Fig. 2 ), upper mediastinal lymph node dissection could not be safely performed. ( A ) Contrast-enhanced computed tomographic scan showing the left brachiocephalic vein (arrows) running between the ascending aorta and trachea. ( B ) 3D computed tomography clearly shows the postaortic brachiocephalic vein, which crossed beneath the aortic arch and connected to the superior vena cava. Ao: descending aorta; Az: azygos vein; LBCA: left brachiocephalic artery; PLBCV: post-aortic left brachiocephalic vein; RBCV: right brachiocephalic vein; RPA: right pulmonary artery; SVC: superior vena cava. Intraoperative image after performing right upper mediastinal lymph node dissection. The postaortic brachiocephalic vein ran into the superior vena cava, just cranial to the azygos connection. Az: azygos vein; LBCA: left brachiocephalic artery; PLBCV: postaortic left brachiocephalic vein; SVC: superior vena cava.