The Radiology of the Superior Intercostal Veins

Abstract

The superior intercostal veins define the pleural reflections of the caudad extent of the posterior junction line. They are paired structures which drain the first three intercostal spaces and join the azygous on the right and the accessory hemiazygous on the left. Because of their location posterior and lateral to the esophagus and trachea, their pleural reflections may be altered early in the course of a focal nodal disease of the posterior mediastinum.

The controversy on chronic cerebrospinal venous insufficiency

“…Lesions caused by incomplete development of axial veins result in aplasia, hypoplasia or hyperplasia of the vessel or as a defective vessel with obstruction from intraluminal lesions (e.g., vein web, malformed valve, or septum) or dilatation (e.g., jugular vein ectasia/aneurysm). Radiological studies of healthy subjects did not demonstrate these types of lesions, [9][10][11][12][13][14][15][16][17][18] while CCSVI-like lesions were described associated to myelopathies. 19,20 Despite the above and other scientific evidences, [21][22][23][24] in clinical practice, due to the inherent variability of the cerebral venous system and the lack of standards, it is difficult to accurately detect CCSVI using current magnetic resonance imaging (MRI) and echo-color Doppler (ECD) sonography techniques, as well as its possible association with neurodegenerative disorders such as MS-something that has generated considerable scientific controversy.…”

“…However, studies performed along the 60's-70's on healthy subjects did not demonstrate these types of lesions. [9][10][11][12][13][14][15][16][17][18] To the contrary, catheter venography studies strongly supports the presence of CCSVI in MS because in 12 studies coming from 8 different Countries the prevalence is always more than 90%. 1,3,[43][44][45][46][47][48][49][50][51][52][53] (Figure 1).…”

Pneumomediastinum and the aortic nipple: The clinical relevance of the left superior intercostal vein

“…The embryogenesis of the LSIV is seldom the focus of developmental reviews, and tends to be present secondary to the reports of larger embryonic venous structures. Correspondingly, the LSIV has been reported to arise from one of the two major cardinal veins, depending on the study cited (Gladstone, ; Campbell and Duechar, ; Lane et al, ; Fasouliotis et al, ; Paval and Nayak, ). Nowhere has the embryogenesis of the LSIV been so thoroughly described as in a case report by Campbell and Duechar (1950) of left‐sided superior vena cava.…”

“…As the azygos vein receives the accessory hemiazygos vein, an increase in azygos blood flow will have collateral implications for the accessory hemiazygos and left superior intercostal veins. Indeed, flow impedance to both the superior and the inferior vena cavae has been shown to divert flow to the accessory hemiazygos and left superior intercostal veins (Lane et al, ; Carter et al, ; Godwin and Chen, ; Byerly and Schlesinger, ). As diverted flow produces venous dilation, obstruction to either vena cava has been demonstrated to manifest radiologically as the spontaneous appearance of an aortic nipple.…”

Arcade-Like Anastomoses between the Posterior Intercostal Arteries in Man

“…Lane et al [4] studied the intercostal veins using imaging tech niques, but they did not report any structures analogous to the arcades between intercostal arteries. In a comprehen-sive radiological study Botenga [5] found anastomoses between the bronchial and intercostal arteries in various pathologies like bronchiectasis and tetralogy of Fallot but no evidence of any arcades between the intercostal arter ies themselves.…”