The right top pulmonary vein is an accessory pulmonary vein that drains directly into the left atrium separately from the four standard pulmonary veins. Its typical course, as in this case, is to pass behind the right main bronchus and drain into either the left atrium or the right superior pulmonary vein ¹. It is an anatomical variant that may be of relevance to surgeons planning mediastinal dissection or esophagectomy, or to cardiologists planning pulmonary vein ablation for atrial fibrillation ².