Eat Vessels of The Thorax

Great Vessels -
Superior Vena Cava

Aorta
Pulmonary Trunk
Sylvia Santos
Superior Vena Cava
Superior Vena Cava
Superior Vena Cava
• Superior vena cava brings deoxygenated
blood from the head and neck, upper limbs
and thorax to the heart.
• Formed by the union of the right and left

brachiocephalic
• Brachiocephalic vein is formed behind the

corresponding sternoclavicular joint by the
union of the internal jugular and subclavian
veins
Superior Vena Cava
Course :
✓ The superior vena cava is about 7 cm long.
✓ It begins behind the lower border of the sternal

end of the first right costal cartilage, pierces the
pericardium opposite the second right costal
cartilage, and terminates by opening into the upper
part of the right atrium behind the third right
costal cartilage.
✓ It has no valves.
Superior Vena Cava
Relations:
• Anterior
✓ a. Chest wall.
✓ b. Internal thoracic vessels.
✓ c. Anterior margin of the right lung and pleura.
✓ d. The vessel is covered by pericardium in its lower half
• Posterior
✓ a. Trachea and right vagus (posteromedial to the upper part of the vena cava)
✓ b. Root of right lung posterior to the lower part.
• Medial
✓ a. Ascending aorta.
✓ b. Brachiocephalic artery.
• Lateral
✓ a. Right phrenic nerve with accompanying vessels.
✓ b. Right pleura and lung
Superior Vena Cava
Superior Vena Cava
Tributaries :
1. Azygos vein
(arches over the root of the right lung
and opens into the superior vena cava
at the level of the second costal
cartilage)
2. Several small mediastinal and

pericardial veins
Superior Vena Cava
Syndrome
• Obstruction of SVC
• Cause – by tumor (e.g Pancoast tumor), lymph node

enlargement, internal thrombosis
- leads to increase in venous pressure above the
obstruction
• Symptoms – dyspnea (shortness of breath), flushed

appearance, swollen neck and chest veins, edema of
face, neck and arms
Superior Vena Cava
Syndrome
Collateral Circulation
Superior Vena Cava
• When the superior vena cava is
obstructed above the opening of the
azygos vein, the venous blood of the
upper half of the body is returned
through the azygos vein; and the
superficial veins are dilated on the
chest up to the costal margin
• When the superior vena cava is

obstructed below the opening of the
azygos veins, the blood is returned
through the inferior vena cava via the
femoral vein; and the superior veins are
dilated on both the chest and abdomen.
Superficial vein connecting the lateral
thoracic vein with the superficial
epigastric vein is known as the
thoracoepigastric vein
Thoracic Aorta
Thoracic Aorta
• The aorta is the great arterial trunk which
receives oxygenated blood from the left
ventricle and distributes it to all parts of
the body.
• Three parts in the thorax:

1 Ascending aorta.
2 Arch of the aorta.
3 Descending thoracic aorta.
Ascending Aorta
• The ascending aorta arises from the upper end of the left
ventricle.
• It is about 5 cm long and is enclosed in the pericardium
Course:
• It begins behind the left half of the sternum at the level of the
lower border of the third costal cartilage.
• It runs upwards, forwards and to the right and becomes
continuous with the arch of the aorta at the sternal end of the
upper border of the second right costal cartilage.
Branches
• Right Coronary artery
• Left Coronary artery
Ascending Aorta
Relations
• Anterior
1 Sternum.
2 Right lung and pleura.
3 Infundibulum of the right ventricle.
4 Root of the pulmonary trunk
5 Right auricle
• Posterior
1 Transverse sinus of pericardium.
2 Left atrium.
3 Right pulmonary artery.
4 Right bronchus
• To the right
1 Superior vena cava.
2 Right atrium
• To the left
1 Pulmonary trunk above.
2 Left atrium below
Arch of Aorta
• Arch of the aorta is the continuation of the ascending aorta.
• It is situated in the superior mediastinum behind the lower half
of the manubrium sternum
Course:
• It begins behind the upper border of the second right
sternocostal joint
• It runs upwards, backwards and to the left across the left side
of the bifurcation of trachea.
• Then it passes downwards behind the left bronchus and on the
left side of the body of the fourth thoracic vertebra. It thus
arches over the root of the left lung.
• It ends at the lower border of the body of the fourth thoracic
vertebra or posterior to the second left sternocostal joint- by
becoming continuous with the descending aorta
Arch of Aorta
Relations :
Arch of Aorta
• Anteriorly and to the left
1 Four nerves from before backwards:
a. Left phrenic.
b. Lower cervical cardiac branch of the left vagus.
c. Superior cervical cardiac branch of left sympathetic chain.
d. Left vagus
2 Left superior intercostal vein, deep to the phrenic nerve and superficial to the vagus nerve.
3 Left pleura and lung.
4 Remains of thymus.
• Posteriorly and to the right

1 Trachea, with the deep cardiac plexus and the tracheobronchial lymph nodes.
2 Oesophagus
3 Left recurrent laryngeal nerve.
4 Thoracic duct.
5 Vertebral column.
• Superiorly
Three branches of arch of aorta
• Inferiorly
1 Bifurcation of the pulmonary trunk.
2 Left bronchus.
3 Ligamentum arteriosum with superficial cardiac plexus on it.
4 Left recurrent laryngeal nerve.
Arch of Aorta
• Branches :
1. Brachiocephalic artery which divides
into the right common carotid and right
subclavian arteries
2. Left common carotid
artery.
3. Left subclavian artery.
Variations
Descending Thoracic Aorta
• Descending thoracic aorta is the
continuation of the arch of the aorta. It
lies in the posterior mediastinum
Course:
• It begins on the left side of the lower
border of the body of the T4
• It descends with an inclination to the right
and terminates at the lower border of the
T12
Relations
• Anterior
1 Root of left lung.
2 Pericardium and heart.
3 Oesophagus in the lower part.
4 Diaphragm
• Posterior
1 Vertebral column.
2 Herniazygos veins
• To the Right Side

1 Oesophagus in the upper part.
2 Azygos vein.
3 Thoracic duct.
4 Right lung and pleura
• To the Left side

1 Left lung and pleura.
Branches
1. Nine posterior intercostal arteries on each side for
the third to eleventh intercostal spaces.
2. The subcostal artery on each side
3. Two left bronchial arteries.
4. Esophageal branches
5. Pericardial branches
6. Mediastinal branches
7. Superior phrenic arteries
Aorta Clinical Anatomy
• Aortic knuckle/knob: In
posteroanterior view of
radiographs of the
chest, the arch of the
aorta is seen as a
projection beyond the
left margin of the
mediastinal shadow. The
projection is called the
aortic knuckle. It
becomes prominent in
old age.
• Coarctation of the aorta is a localised narrowing of
the aorta opposite to or just beyond the
attachment of the ductus arteriosus.
• An extensive collateral circulation develops
between the branches of the subclavian arteries
and those of the descending aorta. These include
the anastomoses between the anterior and
posterior intercostal arteries. These arteries
enlarge greatly and
produce a
characteristic
notching on the
ribs.
Coarctation of the aorta
In coarctation of Aorta
Coarctation of the aorta
‘Figure 3’ Angiogram
on chest
film
The barium study demonstrates the 'Reverse 3

figure' indention of esophagus by pre and post
stenotic aortic dilatation (arrows).
• Aortic arch
aneurysm is a
localised dilatation
of the aorta which
may press upon the
left recurrent
laryngeal nerve
leading to paralysis
of left vocal cord
and hoarseness.
Pulmonary Trunk
Pulmonary Trunk
• The pulmonary trunk starts from the summit of infundibulum of
right ventricle
• It overlies the beginning of ascending aorta.

• It courses to the left and divides into right and left pulmonary
arteries under the concavity of aortic arch at the level of
sternal angle.
• The right pulmonary artery courses to the right behind

ascending aorta, and superior vena cava and anterior to
oesophagus to become part of the root of the lung.
• The left pulmonary artery passes to the left anterior to
descending thoracic aorta to become part of the root of the
left lung. At its beginning, it is connected to the inferior aspect
of arch of aorta by ligamentum arteriosus, a remnant of ductus
arteriosus.
Pulmonary Trunk
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Great Vessels -

Superior Vena Cava

• Formed by the union of the right and left

• Brachiocephalic vein is formed behind the

✓ The superior vena cava is about 7 cm long.

✓ It begins behind the lower border of the sternal

2. Several small mediastinal and

• Cause – by tumor (e.g Pancoast tumor), lymph node

• Symptoms – dyspnea (shortness of breath), flushed

• When the superior vena cava is

• Three parts in the thorax:

• It is about 5 cm long and is enclosed in the pericardium

• Posteriorly and to the right

• To the Right Side

• To the Left side

The barium study demonstrates the 'Reverse 3

• It overlies the beginning of ascending aorta.

• The right pulmonary artery courses to the right behind

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