A 17-year-old boy presented with gynecomastia and multiple firm testicular nodules. The boy underwent a right radical orchiectomy and chemotherapy for mixed germ cell testicular neoplasm. After treatment, follow-up chest radiographs and the scout image from a surveillance CT demonstrated a new finding of an aortic nipple (Fig. 1, arrow) that was not present on previous chest radiographs or CT scans. The CT revealed new thrombus within the left innominate vein with collateral flow through the left superior intercostal vein (arrows) and paravertebral veins, which drained into the azygos vein (arrowhead) (Fig. 2). More cranial images (not shown) revealed a new left innominate vein thrombus.

Fig. 1
figure 1

Scout image from a chest CT

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Fig. 2
figure 2

Axial CT image

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The aortic nipple is a normal variant seen on chest radiographs in 1–9% of the population and is caused by a prominent left superior intercostal vein adjacent to the aortic arch [1]. However, it has also been reported in patients with congenital vascular abnormalities or obstruction of the superior vena cava (SVC), inferior vena cava (IVC) or innominate veins. Therefore, the development of a new aortic nipple on a chest radiograph should raise concern for innominate vein, SVC or IVC thrombosis [1, 2].