Aortosternal venous compression along with bovine arch masquerading as internal jugular vein thrombus: a case report

Abstract

We present the case of a 31-year-old male who presented with pain and swelling of the left side of the neck and left upper limb. Initial ultrasonography demonstrated thrombosis of the left internal jugular vein with partial thrombosis of the left subclavian and axillary veins. Subsequent contrast-enhanced computed tomography of the neck and thorax revealed an anatomical variant of the aortic arch with a common origin of the brachiocephalic artery and left common carotid artery (bovine arch), resulting in significant compression of the left brachiocephalic vein between the aortic arch, clavicle, and manubrium sterni. No mediastinal mass or aneurysm was identified. Computed tomography (CT) venography confirmed severe stenosis of the left brachiocephalic vein, establishing the diagnosis of aorto-sternal venous compression after exclusion of other causes. The patient was managed conservatively with limb elevation and anticoagulation therapy, with marked symptomatic improvement on follow-up.