Double left brachiocephalic vein in a paediatric patient with CHD: a case report

Anomalous brachiocephalic vein (ABCV) is a rare entity of head and neck venous channel variations and malformations. Amongst the five subtypes of ABVC, double left brachiocephalic vein (DLBCV) is the rarest. We present the case of a 1-year-11-month-old syndromic child, who had global developmental delay (GDD) with Sprengel deformity and failure to thrive (suspected Klippel Feil phenotype), who presented to us for the cardiac evaluation. Her 2D echocardiography revealed unobstructed total anomalous supra-cardiac pulmonary venous connection. However, for the delineation of individual pulmonary venous course, CT-pulmonary angiography was advised. CTPA revealed supra-cardiac total anomalous pulmonary venous connection (TAPVC) with incidentally noted DLBCV. Importance of recognition of DLBCV enables us to prevent accidental venous injury during cardiac surgery and to avoid intraoperative technical issues during transvenous pacemaker insertion.