Systemic venous abnormalities are common and in some cases may be associated with congenital heart defects. We report here a case of a 67-year-old woman with bilateral superior vena cava with interruption of the inferior vena cava with hemiazygous continuation in the context of left atrial isomerism. These abnormalities were associated with a small secundum atrial septal defect and patent foramen ovale. The dilated hemiazygous vein was a potential mimicker of aortic pathology. The dilated coronary sinus was a sign of anomalous venous return. The echocardiographist should search systematically for a congenital heart defect on detection of this type of anomalous venous return. Radiological imaging can help to confirm the diagnosis.