Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins: Head, Neck, and Thorax
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
Variations Due to Persistence of Left Common Cardinal
Vein.
The left subclavian may join the left internal jugular vein to form a
trunk that continues almost vertically downward over the arch of the
aorta in front of the root of the left lung and opens into the
coronary sinus of the heart. This variation is known as the
persistent left superior vena cava and results from the retention of
the embryonic arrangement. It occurs (all sources) in about 0.4% of
cases.
A persistent left superior vena cava may be associated with the presence of two azygos veins.
When a left superior vena cava is present, the accessory hemiazygos vein (the remnant of the anterior part of the left cardinal vein) may open into it by arching over the root of the left lung, in a way similar to that in which the azygos (the right cardinal vein) opens into the superior vena cava over the root of the right lung.
The usual left brachiocephalic vein may be absent, or quite small or even rudimentary.
The left innominate vein may receive anomalous pulmonary veins; the longest recorded living history of an individual with this "incompatible with life" variation is forty-two years.
The left superior vena cava may open into the left auricle (atrium) of the heart, coronary sinus, innominate vein, or right superior vena cava.
On occasion, a left superior vena cava communicates with a typical inferor vena cava by means of a channel that is a remnant of a persistent sinus venosus.
In another variation, a vein runs from the left brachiocephalic or from the left superior intercostal vein through the "vestigial fold" (of Marshall) of the pericardium to the vein of Marshall to the coronary sinus. When the coronary sinus is absent the blood flow is reversed.
Variations Due to Persistence of left and Suppression of Right
Common Cardinal Vein.
The right brachiocephalic vein may cross the arch of the aorta to
join a verticle left brachiocephalic vein, thus forming a left
superior vena cava. The right superior vena cava is absent. The
arrangement of the azygos veins under these conditions may be
reversed: a left azygos opens (over the root of the left lung) into
the left superior vena cava, and the now right hemiazygos and
accessory veins are organized in a manner similar to the typical
arrangement of the left hemiazygos veins. This arrangement of veins
may occur independently of any general transposition of the viscera.
There are other variations in the development of the great veins from
the common cardinals, primitive jugular, and anterior and posterior
cardinal veins.
The right superior vena cava is usually connected to the right atrium, but may be joined to the coronary sinus by a vein of substantial length and size.
Doubled superior vena cava has an incidence of 0.16% (a study of 3000 subjects).
Unusual tributaries of the superior vena cava include: the internal thoracic on the right side, the right supreme intercostal, and the thyroidea ima vein.
Ancel and Villemin (1908) (see Poynter, 1922) have classified the anomalies of the superior vena cava as follows:
a) Double superior vena cava without anastomoses. Persistence of the left duct of Cuvier and failure of development of the left innominate vein.b) Double superior vena cava with small anastomoses, persistence of the left duct of Cuvier, and a small innominate development.
c) Double superior vena cava with normal innominate vein.
d) Persistence of the left superior vena cava without atrophy of the right superior vena cava.
The embryological history of the vena cava is well-documented and found in most textbooks of embryology. Variations are associated with the embryologic pattern and consist of persistence of embryological connections alone or in conjunction with atrophy of normally developing channels (Poynter, 1922).
When an accessory vertebral vein is present, it arises from the venous plexus on the vertebral artery and descends through the seven transverse foramina to join the brachiocephalic vein.
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Persistent Left Superior Vena Cava
See Image 119, 
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Image 192, See
Image 193,
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Image 503
Doubled
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Left and Right Cardinal (Persistent)
Oblique (of Marshall)
References
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Gruber, W. (1885) Duplicität der Vena cava superior (11. Fall eigener Beobachtung) bei Verschluss der Mindüng der Vena cava superior sinistra in das Atrium dextrum und deren Auftreten als Abfuhrungskanal der Herzvenen in die Vena anonyma sinistra (sicherer 1. Fall). Arch. Pathol. Anat. Physiol. Klin. Med. 99:492-497.
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Halpert, B. (1927) Complete situs inversus of the vena cava superior. Anat. Rec. 35:38.
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