On an axial contrast-enhanced CT of the thorax at the level of the arch of the aorta, a large venous channel is seen crossing the midline anterior to the brachiocephalic arteries to join the SVC. This vessel is the:

• A Left brachiocephalic vein ✓
• B Right brachiocephalic vein
• C Left superior intercostal vein
• D Accessory hemiazygos vein

Explanation

The left brachiocephalic vein is longer than the right and crosses obliquely from left to right, passing anterior to the three branches of the aortic arch, namely the brachiocephalic trunk, left common carotid and left subclavian arteries. The left superior intercostal vein instead arches around the lateral side of the arch, producing the aortic nipple on a chest radiograph.

Reference: Gray's Anatomy, 42nd ed.

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