Abstract
During an educational dissection of a 72-year-old Chinese male cadaver, the hemiazygos vein (HAV) coursing the left side that drains into the persistent left superior vena cava was observed. The HAV was formed at the junction of the 9th to 11th right posterior intercostal veins, right subcostal vein, 5th to 11th left posterior intercostal veins, and left subcostal vein; it then ascended posteriorly to the thoracic aorta. After collecting the accessory hemiazygos vein, it crossed over the aorta and the pedicle of the left lung via the hemiazygos arch, then converged with a communicative branch (vein of Marshall) that emerged from the left brachiocephalic vein to form the persistent left superior vena cava and entered the pericardium at the level of the sixth thoracic vertebra. Upon opening the pericardium of our cadaver, the persistent left superior vena cava was found to drain directly into the significantly dilated coronary sinus at the level of the eighth thoracic vertebra. The azygos vein was formed by the union of the first to eighth right posterior intercostal veins and appeared to be finer and shorter than the HAV. The persistent left superior vena cava might be the result of incomplete degeneration of the left posterior cardinal vein. Knowledge of such variations could be of great value to surgeons placing peripherally inserted central catheters because incorrect placement of the azygos venous system can be detrimental to the patient. In addition, during heart surgery, awareness of such variations may prevent major complications, such as hemorrhage or damage to vascular structures, and possibly also provide new insights and perspectives to cardiovascular surgeries.
Similar content being viewed by others
References
Badagabettu SN, Shetty P, D'Souza MR (2016) A unique variation of azygos system of veins. J Cardiovasc Echography 26:61–64
Cendrowska-Pinkosz M, Urbanowicz Z (2000) Analysis of the course and the ostium of the oblique vein of the left atrium. Folia Morphol 59:163–166
Franklin I, Gilmore C (2015) Placement of a peripherally inserted central catheter into the azygous vein. J Med Radiat Sci 62:160–162
do Giang TC, Rajeesh G, Vaidyanathan B (2014) Prenatal diagnosis of isolated interrupted inferior vena cava with azygos continuation to superior vena cava. Ann Pediatr Cardiol 7:49–51
Keskin S, Keskin Z, Sekmenli N (2013) The independent right and left azygos veins with hemiazygos absence: a rare case presentation. Case Rep Vasc Med 2013:282416
Kutoglu T, Turut M, Kocabiyik N, Ozan H, Yildirim M (2012) Anatomical analysis of azygos vein system in human cadavers. Rom J Morphol Embryol 53:1051–1056.
Namisaki H, Nishigami K, Murakami M, Yamamoto T, Ogata Y, Tomita A (2013) Congenital absence of inferior vena cava with azygos continuation revealed by vascular echo in a patient with pulmonary thromboembolism and deep vein thrombosis: a case report. Ann Vasc Dis 6:195–197
Ozbek A, Dalcik C, Colak T, Dalcik H (1999) Multiple variations of the azygos venous system. Surg Radiol Anat 21:83–85
Pyrzowski J, Spodnik JH, Lewicka A, Poplawska A, Wojcik S (2007) A case of multiple abnormalities of the azygos venous system: a praeaortic interazygos vein. Folia Morphol 66:353–355
Quraishi MB, Mufti O, Wase A (2010) Absent left and right superior vena cava and azygos continuation of inferior vena cava: a rare anomaly of systemic venous return. J Invasive Cardiol 22:E159–161
Tatar I, Denk CC, Celik HH, Oto A, Karaosmanoglu DA, Ozdemir BM, Surucu SH (2008) Anatomy of the azygos vein examined by computerized tomography imaging. Saudi Med J 29:1585–1588
Yildiz AE, Cayci FS, Genc S, Cakar N, Fitoz S (2014) Right nutcracker syndrome associated with left-sided inferior vena cava, hemiazygos continuation and persistant left superior vena cava: a rare combination. Clin Imaging 38:340–345
Acknowledgements
This study was supported by the National Natural Science Foundation of China (81772134), Wu Jie-Ping Medical Foundation of the Minister of Health of China (320.6750.14118), and the 9th Educational Teaching Reform and Research Foundation of Xinjiang Medical University (YG2017053).
Author information
Authors and Affiliations
Contributions
AS collected the data; CSG edited the manuscript; LFX managed the data and participated in writing the manuscript; RA collected data; WSQ collected and managed the data; XK participated in the development of the protocol and project development and edited the manuscript; YA participated in the development of the protocol and project.
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Liu, F., Ruze, A., Amuti, S. et al. A rare variation of the hemiazygos vein draining into the persistent left superior vena cava. Anat Sci Int 94, 269–273 (2019). https://doi.org/10.1007/s12565-019-00477-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12565-019-00477-3