An asymptomatic 16-year-old African-American boy who underwent complete tetralogy of Fallot (TOF) repair at age 4 was being followed for aortic regurgitation and pulmonic stenosis. Magnetic resonance (MR) imaging of the chest during a follow-up visit demonstrated a left retroesophageal innominate (or brachiocephalic) vein coursing posterior to the descending aorta, trachea, and esophagus before communicating with the azygos vein and right superior vena cava (Figs. 1, 2). The patient was without any clinical complications as a consequence of this cardiac anomaly.
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