Congenital anomalies of the thoracic veins, although uncommon, can be of the utmost clinical and surgical significance. These venous anomalies may be subdivided into systemic and pulmonary. Most systemic venous abnormalities are incidental findings, whereas pulmonary vein malformations coexist with coronary heart disease, especially atrial septal defect. Although cardiac ultrasonography remains the initial noninvasive imaging modality, magnetic resonance imaging with ultrafast sequences is of great diagnostic value because multiplanar 3-dimensional reconstructions may be made.