Normal variations of the superior vena cava and azygos venous system depiction by CT scan in the adult Thai population

Abstract

Background: Identification of normal variations to the thoracic central venous system anatomy is essential in radiological intervention and cardiothoracic surgery to prevent complications.

Purpose: To estimate the prevalence and pattern of normal variations of superior vena cava (SVC) and azygos venous system as well as factors associated with normal variations of SVC.

Material and methods: Venous-phase chest CT of 1336 patients were retrospectively reviewed. Age, sex, and underlying disease were recorded. SVC diameter and cross-sectional area were measured to evaluate for associations with normal variations.

Results: The prevalence of normal anatomical variations of SVC and azygos venous system were 0.3% and 1.5%, respectively. Duplicated SVC was the most common variations. The most common variation for the azygos venous system was the connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein (12/1336 cases, 0.9%). The median (interquartile range [IQR]) cross-sectional area compared between normal SVC (297.2 mm²) and duplicated SVC (223.5 mm²) showed a statistically significant difference (P = 0.033).

Conclusion: This study determined the prevalence of rare normal variations of the azygos venous system, a connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein. The prevalence of normal variations of the SVC and azygos venous system in the adult Thai population was similar with that of previous publications. Cross-sectional area was the only factor with a significant association with SVC variations.

Keywords: Normal variation; azygos venous system; computed tomography; superior vena cava.