Excessive anteriorisation of the superior vena cava associated with an azygos lobe

A wide variety of congenital vascular anomalies of the superior mediastinum exist. Being clinically silent, most of these anomalies are detected incidentally on plain radiographs or CT scans where they could be mistaken for mediastinal masses. Familiarity with these anomalies is very important for correct interpretation and avoidance of confusion. We present a case of a mediastinal mass detected accidentally on plain radiography which on further radiological investigation was found to be an unreported normal variant of the superior vena cava (SVC). CT scans of the thorax and superior vena cavograms showed excessive anteriorisation of the SVC in the presence of an azygos lobe. After reviewing the literature and the embryology of the SVC and azygos lobe, we postulate that the variation in the location of the SVC was possibly due to the presence of the azygos lobe.