A rare case of right brachiocephalic vein (RBV) following an extramediastinal and intrapulmonary course in the anterior portion of the azygos fissure is presented. The appearance of the RBV and superior vena cava (SVC) on the chest radiograph in patients with an azygos lobe reflects the variable relationship between these veins and their mediastinal attachments. Computed tomography (CT) can easily demonstrate the mediastinal vascular anatomy thereby allowing identification of such variants and differentiation from anomalous pulmonary veins draining into the systemic vein.
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