Neurovasculature of the thoracic wall
After completing this study unit you will be able to:
- Identify the main arteries of the thoracic wall and their branches.
- Describe the venous drainage of the thoracic wall.
- List the main nerves of the thoracic wall.
The thoracic wall is a musculoskeletal framework consisting of the rib cage, muscles, fascias and skin that enclose the thoracic cavity. It has a rich arterial supply via branches that arise from three main sources: the subclavian artery, axillary artery and the thoracic aorta. The veins of the thoracic wall initially follow a similar course to that of their arterial counterparts, however most of them terminate by draining into the azygos venous system. Lastly, the nervous supply to the thoracic wall mainly stems from the anterior rami of the spinal nerves T1-T12 (a.k.a. intercostal/subcostal nerves). Additional supply to the thoracic wall stems from the preterminal branches of the brachial plexus, such as the medial and lateral pectoral nerves.
Watch this video to get an overview of the main nerves of the thoracic wall.
Watch this video on the blood vessels of the thoracic wall.
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Take a closer look at the arteries, veins and nerves of the thoracic wall from an anterior perspective.
Now take a look at the vascular structures of the thoracic wall from a lateral view.
Internal thoracic artery:
Origin: Subclavian artery
Branches: Musculophrenic artery, superior epigastric artery, upper 6 anterior intercostal arteries
Superior thoracic artery:
Origin: Axillary artery
Lateral thoracic artery:
Origin: Axillary artery
Anterior intercostal arteries:
Origin: Internal thoracic artery (upper 6), musculophrenic artery (lower 3)
Posterior intercostal arteries:
Origin: Supreme intercostal artery (upper 2), thoracic aorta (lower 10)
Origin: Thoracic aorta
Anterior intercostal veins:
Drain into: Internal thoracic vein
Posterior intercostal veins:
Supreme intercostal vein drains into: Brachiocephalic vein
Superior intercostal vein drains into: Azygos/left brachiocephalic vein
Right 4th-11th drain into: Azygos vein
Left 4th-7th drain into: Accessory intercostal vein
Left 8th-11th drain into: Hemiazygos vein
Superior intercostal vein:
Drains into: Left brachiocephalic vein (left), azygos vein (right)
Drains into: Azygos vein
Anterior rami of spinal nerves T1-T11: Intercostal nerves
Anterior ramus of spinal nerve T12: Subcostal nerve
Long thoracic nerve (C5, C6, C7)
Lateral pectoral nerve (C5, C6, C7)
Medial pectoral nerve (C8, T1)
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