MyPACS.net: Radiology Teaching Files > Case 812771

previously visited AORTIC NIPPLE
Contributed by: Dr Phillip Silberberg, Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
Patient: male
History:

An aortic nipple is a radiological sign that represents the left superior intercostal vein as it runs around the aortic arch before joining the left brachiocephalic vein. It is often visualized at the margin of the aortic knob on posteroanterior or anteroposterior chest radiographs. In certain conditions the aortic nipple can become enlarged and mimic lymphadenopathy or aortic aneurysm. This sign can be found in anywhere from 1.4-9.5% of people depending on the study used. Aortic nipple is usually found in normal, healthy patients, and is of limited clinical significance.  No treatment is needed other than treatment of the underlying condition.
In about 75% of people CT scans show the left superior intercostal vein connecting with the accessory hemiazygous vein. When this happens it allows blood to flow back to the heart through the inferior vena cava or the hemiazygous to left subclavian vein. A rare congenital condition resulting in the absence of the azygos vein can result in enlargement of the left superior intercostal vein, resulting in an enlarged aortic nipple.


Conditions that can cause an aortic nipple are conditions that cause an increase in venous flow such as a recumbant position, portal veinous hypertension secondary to hepatofugal shunting from the liver, or congenital anomalies of the caval, azygos or hemiazygos circulation. It is also caused by increased venous resistance as in congestive heart failure, Budd Chiari sydrome and vena cava obstructions.

References:

Worrell, John et al. Chest Case of the Day. American Journal of Radiology. June 1992.

Medpix. Arotic Nipple, topic 6776. http://rad.usuhs.edu/medpix. Last modified 10/10/2005.

Malcolm K. Hatfield, et al. Congenital Absence of the Azygos Vein: A Cause fo "Aortic Nipple" Enlargement. American Journal of Roentgenology. 1987.


Contributed by: Robert Loveday Medical Student.

Philip J. Silberberg, M.D., Department of Radiology, Children’s Hospital, Creighton University, and University of Nebraska Medical Center, Omaha, NE.

Images:[small]larger

Fig. 1: Here the left superior intercostal vein is seen end on as a local protuberance of the aortic arch.
Findings: Aortic nipple.
Diagnosis: Aortic nipple.
Discussion:

An aortic nipple is a radiological sign that represents the left superior intercostal vein as it runs around the aortic arch before joining the left brachiocephalic vein. It is often visualized at the margin of the aortic knob on posteroanterior or anteroposterior chest radiographs. In certain conditions the aortic nipple can become enlarges and mimic lymphadenopathy or aortic aneurysm. This sign can be found in anywhere from 1.4-9.5% of people depending on the study used. Aortic nipple is usually found in normal, healthy patients, and is of limited clinical significance.


In about 75% of people CT scans show the left superior intercostal vein connecting with the accessory hemiazygous vein. When this happens it allows blood to flow back to the heart through the inferior vena cava or the hemiazygous to left subclavian vein. A rare congenital condition resulting in the absence of the azygos vein can result in enlargement of the left superior intercostal vein, resulting in an enlarged aortic nipple.


Conditions that can cause and aortic nipple are conditions that cause an increase in venous flow such as a recumbant position, hypertension of the portal vein or congenital anomalies of the caval, azygos or hemiazygos circulation. It is also caused by increased venous resistance as in congestive heart failure, Budd Chiari sydrome and vena cava obstructions.





References: References:

Worrell, John et al. Chest Case of the Day. American Journal of Radiology. June 1992.

Medpix. Arotic Nipple, topic 6776. Http://rad.usuhs.edu/midpix. Last modified 10/10/2005.

Malcolm K. Hatfield, et al. Congenital Absence of the Azygos Vein: A Cause fo "Aortic Nipple" Enlargement. American Journal of Roentgenology. 1987.
Jeffrey R. Galvin, M.D.; Michael P. D'Alessandro, M.D.; Yasayuki Kurihara, M.D.
Peer Review Status: Internally Peer Reviewed

Contributed by:
Robert Loveday Medical Student Creighton University;

Philip J. Silberberg, M.D., Department of Radiology, Children’s Hospital, Creighton University, and University of Nebraska Medical Center, Omaha, NE.

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Additional Details:

Case Number: 812771Last Updated: 04-16-2007
Anatomy: Chest   Pathology: Normal/Variants
Modality: Conventional RadiographAccess Level: Readable by all users
Keywords: aortic nipple, left superior intercostal vein

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