Left superior intercostal vein opacification
non specific cough
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C+ arterial phase
Note the opacified left superior intercostal vein (LSICV)- its position correlates with the aortic "nipple" that is seen on chest X rays.
It is seen to drain into the acccessory hemiazygous to left of midline which in turn drains into the azygous system after crossing the midline.
Opacification and more importantly dialtion of azygous and accessory systems usually indicates venous obstruction of some kind, in this case there was none.
At times if the contrast density in the LSICV is similar to the aorta its curvilinear course near the arch can mimic a dissection flap- the so called "pseudo dissection".
- Hartman T. Pearls and Pitfalls in Thoracic Imaging, Variants and Other Difficult Diagnoses. (2011) ISBN:0521119073. Read it at Google Books - Find it at Amazon