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Topographic Anatomy of the Vertebral Venous System in the Thoracic Inlet

¹ All authors: Department of Radiology, Mitsui Memorial Hospital, 1-Kanda Izumicho Chiyoda-ku, Tokyo 101-8643, Japan.

View larger version (16K): [in a new window]   Fig. 1A. —Diagrams of vertebral venous system in thoracic inlet. Anterior view. Az = azygos vein, EDV = epidural venous plexus, DCV = deep cervical vein, IVV = intervertebral vein, LBCV = left brachiocephalic vein, LPV = longitudinal prevertebral vein, RSICV = right superior intercostal vein, VV = vertebral vein, ICV = intercostal vein. Asterisk indicates esophageal veins, dotted line indicates peripheral branches of deep cervical vein in back neck.

View larger version (28K): [in a new window]   Fig. 1B. —Diagrams of vertebral venous system in thoracic inlet. Axial view. A = anterior epidural venous plexus, B = basivertebral veins, C = musculus longissimus colli, D = deep cervical veins, I = intervertebral veins, L = longitudinal prevertebral veins, P = posterior epidural venous plexus, S = musculus semispinalis cervicis, V = vertebral veins.

View larger version (124K): [in a new window]   Fig. 2A. —Vertebral veins in 70-year-old woman with bladder cancer. Transverse contrast-enhanced CT scans of neck show vertebral arteries (A, arrowheads) and vertebral veins (V, short arrows). Internal jugular veins (asterisks), common carotid arteries (stars), and subclavian arteries (SC, long arrows, B and C) are also seen.

View larger version (110K): [in a new window]   Fig. 2B. —Vertebral veins in 70-year-old woman with bladder cancer. Transverse contrast-enhanced CT scans of neck show vertebral arteries (A, arrowheads) and vertebral veins (V, short arrows). Internal jugular veins (asterisks), common carotid arteries (stars), and subclavian arteries (SC, long arrows, B and C) are also seen.

View larger version (77K): [in a new window]   Fig. 2C. —Vertebral veins in 70-year-old woman with bladder cancer. Transverse contrast-enhanced CT scans of neck show vertebral arteries (A, arrowheads) and vertebral veins (V, short arrows). Internal jugular veins (asterisks), common carotid arteries (stars), and subclavian arteries (SC, long arrows, B and C) are also seen.

View larger version (123K): [in a new window]   Fig. 3A. —Photographs of dissection of perivertebral venous plexus in cadaver of 80-year-old with no evidence of neck or chest disease. Anterior view. Trachea, pharynx, and surrounding soft tissue have been removed. Right and left longitudinal prevertebral veins (stars) are located medially to musculus longissimus colli (L) and in front of cervical vertebrae. Anastomosis (arrowheads) between bilateral longitudinal prevertebral veins and anastomoses (long thick arrows) between longitudinal prevertebral and vertebral veins (V) are identified. Caudal portion of right (short arrow) and left (long thin arrow) longitudinal prevertebral veins communicate with right superior intercostal vein (SIC) and esophageal vein (E), respectively. D = deep cervical vein, A = vertebral artery.

View larger version (117K): [in a new window]   Fig. 3B. —Photographs of dissection of perivertebral venous plexus in cadaver of 80-year-old with no evidence of neck or chest disease. Posterior view. musculus trapezius, musculus semispinalis capitis, musculus splenius cervicis and capitis, and musculus longissimus cervicis have been removed. Peripheral branches (arrows) and trunk (arrowheads) of deep cervical veins are seen on surface of musculus semispinalis cervicis. Bilateral peripheral branches of deep cervical veins are anastomosed around spinous process of cervical vertebrae.

View larger version (123K): [in a new window]   Fig. 3C. —Photographs of dissection of perivertebral venous plexus in cadaver of 80-year-old with no evidence of neck or chest disease. View from right. Right lung and part of right brachiocephalic artery and vein have been removed. Esophagotracheal vein (arrowheads) is identified at right aspect of trachea (T), which drains into posterior aspect of right brachiocephalic vein. Anastomoses (long arrow) between right longitudinal prevertebral vein (LP) and right superior intercostal vein (SIC, short arrow) are seen. A = azygos vein.

View larger version (125K): [in a new window]   Fig. 3D. —Photographs of dissection of perivertebral venous plexus in cadaver of 80-year-old with no evidence of neck or chest disease. View from left. Aortic arch has been removed. Two branches of left longitudinal prevertebral veins (arrows) enter posterior aspect of upper esophagus (E). S = left superior intercostal vein.

View larger version (132K): [in a new window]   Fig. 4A. —Longitudinal prevertebral veins in 72-year-old man with left brachiocephalic vein obstruction after left upper lobectomy because of lung cancer. Transverse contrast-enhanced CT scan shows anastomosis (black arrow) between two longitudinal prevertebral veins behind esophagus. Anastomosis (white arrow) between right vertebral vein (V, arrowhead) and longitudinal prevertebral vein is also noted.

View larger version (130K): [in a new window]   Fig. 4B. —Longitudinal prevertebral veins in 72-year-old man with left brachiocephalic vein obstruction after left upper lobectomy because of lung cancer. Transverse contrast-enhanced CT scan obtained 1 cm below A shows longitudinal prevertebral veins (LP, arrows).

View larger version (156K): [in a new window]   Fig. 5. —Photograph shows dissection (viewed from back) of anterior epidural venous plexus in cadaver of 68-year-old with no evidence of neck and chest disease. Back neck muscle and all of arches of cervical vertebrae have been removed. Anterior epidural venous plexuses (asterisks) are seen at posterior surface of cervical vertebral body and lateral to posterior longitudinal ligament. Anterior epidural venous plexuses anastomose vertebral vein through intervertebral vein (arrow).

View larger version (99K): [in a new window]   Fig. 6. —Anterior epidural venous plexus in 67-year-old man with left upper lobectomy because of lung cancer. Transverse contrast-enhanced CT scan shows anterior epidural venous plexus (arrow) located at anterior aspect of spinal canal, through which right and left vertebral veins anastomose. Note no evidence of opacification of venous plexus located at posterior aspect of spinal canal.

View larger version (106K): [in a new window]   Fig. 7. —Posterior external plexus in 66-year-old man with prostate cancer. Transverse contrast-enhanced CT scan shows posterior external plexus as Y-shaped opacification (arrow) around spinous process of vertebrae.

View larger version (138K): [in a new window]   Fig. 8. —Basivertebral vein in 70-year-old man with stenosis of left brachiocephalic vein resulting from aortic arch aneurysm. Transverse contrast-enhanced CT scan shows basivertebral vein (arrowheads) through which right longitudinal prevertebral vein (LP, white arrow) located behind esophagus anastomoses anterior epidural venous plexus (AE, black arrow). Bilateral vertebral veins (asterisks) running posteriorly from brachiocephalic veins are well opacified.

View larger version (124K): [in a new window]   Fig. 9A. —Bilateral superior intercostal veins in 54-year-old woman with left upper lobectomy because of lung cancer. Transverse contrast-enhanced CT scan shows opacified left longitudinal prevertebral vein (LP, thick white arrow). Bilateral superior intercostal veins (SIC, thin white arrows) are opacified via epidural venous plexus (AE, arrowheads) and intervertebral veins (IV, black arrows).

View larger version (104K): [in a new window]   Fig. 9B. —Bilateral superior intercostal veins in 54-year-old woman with left upper lobectomy because of lung cancer. Transverse contrast-enhanced CT scan obtained 2 cm below A shows right superior intercostal vein (RSIC, thick white arrow) running forward to join azygos vein and left longitudinal prevertebral vein uniting with left superior intercostal vein (LSIC, thin white arrow). AE and arrowheads indicate anterior epidural venous plexus.

View larger version (158K): [in a new window]   Fig. 10A. —Ipsilateral posterior neck pathway in 54-year-old woman with spontaneous thrombosis of axillary vein termed "effort thrombosis." Right upper extremity venogram shows that right axillary vein (Ax, arrowhead) is thrombosed and that contrast material runs forward to posterior neck and reconstitutes right vertebral vein (V, straight arrow) via veins of posterior neck. Right vertebral vein empties into brachiocephalic vein distal to obstruction. Anterior jugular arch (Aj, curved arrow) is also opacified.

View larger version (92K): [in a new window]   Fig. 10B. —Ipsilateral posterior neck pathway in 54-year-old woman with spontaneous thrombosis of axillary vein termed "effort thrombosis." Transverse contrast-enhanced CT scan shows opacified right vertebral vein (V, arrow) located at right aspect of trachea (T). Note right brachiocephalic vein (BC, arrowhead) is located anterolateral to right vertebral vein.

View larger version (148K): [in a new window]   Fig. 11A. —Contralateral posterior neck pathway in 23-year-old woman with stenosis of left brachiocephalic vein resulting from anterior mediastinal tumor. Early phase left upper extremity venogram shows that most of contrast material runs forward to right brachiocephalic vein through anterior jugular arch (A), then drains into superior vena cava (S); however, left vertebral vein (V, arrowheads) and internal jugular vein (IJ, arrow) are also opacified. Left brachicephalic vein is compressed and occluded by tumor.

View larger version (162K): [in a new window]   Fig. 11B. —Contralateral posterior neck pathway in 23-year-old woman with stenosis of left brachiocephalic vein resulting from anterior mediastinal tumor. Delayed phase left upper extremity venogram shows bilateral vertebral veins (arrows) and perivertebral venous plexus (P) more clearly than early phase. RV = right vertebral vein, LV = left vertebral vein, SVC = superior vena cava.

View larger version (100K): [in a new window]   Fig. 12. —Downhill varices in 62-year-old man with left upper lobectomy because of lung cancer. Transverse contrast-enhanced CT scan shows that right half (arrows) of esophagus (E) is opacified through longitudinal prevertebral vein, indicating downhill varices.

View larger version (97K): [in a new window]   Fig. 13A. —Right vertebral vein resembles paratracheal node in 62-year-old man with lung cancer in left upper lobe. Early (A) and delayed (B) phase scans of transverse contrast-enhanced CT show nonenhancing small nodule (arrow, A) at right aspect of trachea, which is similar to paratracheal node. On delayed phase scan, nodule (arrow, B) adjacent to trachea is enhanced same as vessels. Although vertebral vein usually ends at upper portion of brachiocephalic vein, right vertebral vein ends at lower portion of right brachiocephalic vein in this particular patient, which is why right vertebral vein resembles right paratracheal node.

View larger version (89K): [in a new window]   Fig. 13B. —Right vertebral vein resembles paratracheal node in 62-year-old man with lung cancer in left upper lobe. Early (A) and delayed (B) phase scans of transverse contrast-enhanced CT show nonenhancing small nodule (arrow, A) at right aspect of trachea, which is similar to paratracheal node. On delayed phase scan, nodule (arrow, B) adjacent to trachea is enhanced same as vessels. Although vertebral vein usually ends at upper portion of brachiocephalic vein, right vertebral vein ends at lower portion of right brachiocephalic vein in this particular patient, which is why right vertebral vein resembles right paratracheal node.

View larger version (106K): [in a new window]   Fig. 13C. —Right vertebral vein resembles paratracheal node in 62-year-old man with lung cancer in left upper lobe. Transverse contrast-enhanced delayed phase CT scans shows that right vertebral vein (arrows) is accompanied by vertebral artery (arrowhead, A) on upper axial image (C) and drains into posterior aspect of right brachiocephalic vein (asterisk, D) on lower axial image (D). S = right subclavian artery, star = left brachiocephalic vein.

View larger version (76K): [in a new window]   Fig. 13D. —Right vertebral vein resembles paratracheal node in 62-year-old man with lung cancer in left upper lobe. Transverse contrast-enhanced delayed phase CT scans shows that right verterbal vein (arrows) is accompanied by vertebral artery (arrowhead, A) on upper axial image (C) and drains into posterior aspect of right brachiocephalic vein (asterisk, D) on lower axial image (D). S = right subclavian artery, star = left brachiocephalic vein.

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