Cardiovascular CT angiography in systemic and pulmonary venous anomalies of the thorax.

Thoracic venous anomalies are often asymptomatic and may go undetected by non-dedicated imaging studies. However, they have significant clinical relevance, as they can affect surgical planning, complicate interventional procedures, and predispose patients to pathological conditions such as arrhythmias, paradoxical embolism, and thrombosis. Understanding their embryologic development is critical for accurate diagnosis and differentiation from pathologic mimics. Major anomalies include left superior vena cava, retroaortic and retroesophageal left brachiocephalic veins, interruption of the inferior vena cava with azygos continuation, and various forms of anomalous pulmonary venous connections. Although many of these anomalies do not require surgical correction, their identification is essential to optimize procedural planning, particularly in patients with congenital heart disease where surgical modifications may be required. Failure to recognize these anomalies can lead to misdiagnosis, unnecessary interventions, and increased procedural risk. This review highlights the importance of identifying thoracic venous anomalies on imaging studies to ensure accurate diagnosis, prevent complications, and improve patient management.