Venous drainage of the thoracic wall

Last revised by Dr Daniel J Bell on 22 Jul 2021

The venous drainage of the thoracic wall drains deoxygenated venous blood from the periphery of the thoracic cage back into the systemic circulation.

Gross anatomy

Anterior thoracic wall
Anterior intercostal veins

The anterior intercostal veins originate from the intercostal space just inferior to anterior aspects of their respective ribs and drain into the internal thoracic and musculophrenic veins.

Posterior thoracic wall
Posterior intercostal veins

The posterior intercostal veins originate from the intercostal space just inferior to posterior aspects of their respective ribs. In the right side, the 4th to 11th posterior intercostal veins and subcostal vein drain into the azygos vein. The 4th to 7th (sometimes 8th) left-sided posterior intercostal veins drain into the accessory hemiazygos vein. The 8th to 11th left-sided posterior intercostal and subcostal veins drain into the hemiazygos vein.

Supreme intercostal vein

The supreme intercostal vein drains the 1st intercostal space posteriorly opening into the vertebral or brachiocephalic veins.

Superior intercostal vein

The posterior 2nd and 3rd intercostal spaces are drained by their respective posterior intercostal veins into a single vessel, the superior intercostal vein, into the azygos and brachiocephalic veins in the right and left sides respectively.

Variant anatomy

  • the superior intercostal veins may additionally drain the 4th intercostal space
  • the accessory hemiazygos vein may drain the left 8th intercostal space posteriorly

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