Retroesophageal Left Brachiocephalic Vein with Right-Sided Aortic Arch in Tetralogy of Fallot: A Rare Venous Anomaly Demonstrated on Computed Tomography Angiography

A 14-year-old child with recurrent cyanotic spells at the age of 9 months underwent echocardiography at that time, which revealed tetralogy of Fallot (TOF). Follow-up computed tomography angiography revealed TOF with valvular pulmonary stenosis and a right-sided aortic arch with mirror image branching. Interestingly, an unusual anomalous course of the left brachiocephalic vein was seen. Instead of coursing anterior to the aortic arch, the left brachiocephalic vein had a U-shaped course like a garland, where it descended vertically down behind the esophagus and the descending aorta, crossed the midline at T4 level of the vertebral body, and then ascended upwards to join the superior vena cava. This case highlights the role of computed angiography in depicting anomalous venous anatomy in TOF, which can have potential clinical implications.