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Intercostal Veins - want to learn more about it?

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Intercostal Veins

Introduction

The intercostal space is the space between the ribs, and it is comprised of three muscular layers and a neurovascular bundle which runs between the intermediate and inner layers of these muscles. In this article we will discuss the gross and functional anatomy of the intercostal veins.

We will also discuss the clinical relevance of the structure, and provide a summary of key points at the end of the article.

Anatomy

Topography

The neurovascular bundle of each rib consists of the intercostal artery, vein and nerve. The neurovascular bundle runs directly under the lower border of each rib. The vein is the superior most of the three, with the artery below, and the nerve lowest.

Each space contains one posterior and two anterior intercostal veins which runs with the arteries of the same name. The anterior intercostal veins follow the same course as the arteries, and drain into internal thoracic and musculophrenic veins.

Anterior intercostal veins - ventral view

Drainage

The posterior intercostal veins drain into the azygos (right side) and hemiazygos and accessory hemiazygos vein (left side). The name azygos originates from the Greek word ‘Zyg’ meaning paired and A means not. The azygos vein does not have a pair (instead there are two separate veins that drain the left posterior thorax and abdomen i.e. the hemiazygos and accessory hemiazygos). The posterior intercostal vein of the first space drains into vertebral vein or brachiocephalic vein of the same side.

The superior intercostal vein is formed by the union of second, third and sometimes fourth posterior intercostal veins which drain into azygos vein on right side and left brachiocephalic vein on left side. The left superior intercostal vein passes over the arch of aorta medial to phrenic and lateral to vagus nerve on its way to brachiocephalic. In the remaining lower eight spaces right sided posterior intercostal veins open into the azygos and left sided drain into hemiazygos and accessory hemiazygos veins.

Superior intercostal vein

The azygos vein drains the posterior thoracic and abdominal wall, and is formed by the confluence of the ascending lumbar veins and the right subcostal vein at vertebral level T12. The azygos vein arches over the right main bronchus, in order to join the superior vena cava. The azygos vein also drains the pericardial veins, bronchial veins and vertebral venous plexuses.

Azygous vein - ventral view

The hemiazygos vein mirrors the lower part of the azygos vein, and receives the 9th to 11th posterior intercostal veins as well as the subcostal vein. The accessory hemiazygos vein receives posterior intercostal veins from 4th to 8th space and left bronchial veins. The hemiazygos and accessory hemiazygos vein drain into the azygos vein at the level of T7-8 that drains into the superior vena cava (at T5-T6).

Hemiazygous vein - ventral view

Clinical aspects

Pleural drain- For pleural drainage a needle is inserted just above the rib in order to avoid damage to the neurovascular bundle which runs at the lower border of the rib.

Enlarged azygos vein- This can result from overhydration, pregnancy, aortoazygous fistula, constrictive pericarditis, Superior vena cava obstruction, inferior vena cava obstruction, portal hypertension and any other cause of right heart output failure. CT scan is useful technique to diagnose this condition and can also be useful to evaluate the etiology.

Summary

  • The anterior intercostal veins follow the arteries.
  • The intercostal veins run above the intercostal arteries, which run above the intercostal nerves.
  • The posterior intercostal veins drain into the azygos vein (right side), and hemiazygos and accessory hemiazygos veins (left side). The latter two veins ultimately drain into the azygos vein.
  • The azygos vein then drains into the superior vena cava.

Intercostal Veins - want to learn more about it?

Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster.

Sign up for your free Kenhub account today and join over 852,397 successful anatomy students.

“I would honestly say that Kenhub cut my study time in half.” – Read more. Kim Bengochea Kim Bengochea, Regis University, Denver

Show references

References:

  • Frank H.Netter MD: Atlas of Human Anatomy, 5th Edition, Elsevier Saunders.
  • Chummy S.Sinnatamby: Last’s Anatomy Regional and Applied, 12th Edition, Churchill Livingstone Elsevier.
  • Richard L. Drake, A. Wayne Vogl, Adam. W.M. Mitchell: Gray’s Anatomy for Students, 2nd Edition, Churchill Livingstone Elsevier.
  • Luijkx T. MD and Knipe H. MD et al: Left superior intercostal vein. Radiopaedia.org (accessed 18/03/2016).
  • Shetty A. MD and Knipe H. MD et al: Azygos venous system. Radiopaedia.org (accessed 18/03/2016).
  • Shetty A. MD and Knipe H. MD et al: Accessory hemiazygos vein. Radiopaedia.org (accessed 18/03/2016).

Author, Review and Layout:

  • Shahab Shahid
  • Uruj Zehra
  • Catarina Chaves

Illustrators:

  • Anterior intercostal veins - ventral view - Yousun Koh
  • Superior intercostal vein  - lateral view - Paul Kim
  • Azygos vein - ventral view - Yousun Koh
  • Hemiazygos vein - ventral view - Yousun Koh
© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

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