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# Internal thoracic veins

The internal thoracic veins run beside the artery of the same name inside the front [chest](https://durgical.com/en/anatomy/region/chest/) wall and drain it into the brachiocephalic veins.

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## What it is

Veins running with the internal thoracic artery.

## What it does

Drain the front chest wall into the brachiocephalic veins.

## Key points

- Usually two veins flank the artery in the lower spaces and merge into one vein, medial to the artery, that ends in the brachiocephalic vein
- Link the superior and [inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) systems through the superior and inferior epigastric veins, a collateral path that enlarges when either cava is blocked
- Recipient veins of choice for free-flap breast reconstruction, together with the internal thoracic artery

## Key facts

**Drains**
Anterior chest wall and intercostal spaces, breast (perforating veins); superior epigastric and musculophrenic veins

**Into**
Brachiocephalic vein of same side

## Relations

**Course**
From the musculophrenic and superior epigastric veins at the 6th space they ascend behind the [costal cartilages](https://durgical.com/en/anatomy/costal-cartilage/) beside the artery, collect anterior intercostal and [perforating veins](https://durgical.com/en/anatomy/perforating-veins/), and end in the [brachiocephalic vein](https://durgical.com/en/anatomy/brachiocephalic-vein/) of the same side

**In front**
Costal cartilages and the front ends of the [internal intercostal muscles](https://durgical.com/en/anatomy/internal-intercostal-muscles/)

**Behind**
Endothoracic fascia and [pleura](https://durgical.com/en/anatomy/pleura/) above; the [transversus thoracis muscle](https://durgical.com/en/anatomy/transversus-thoracis-muscle/) below

**Lateral**
The [internal thoracic artery](https://durgical.com/en/anatomy/internal-thoracic-artery/), where the single upper vein lies on its medial side

**Medial**
Sternal edge and the [parasternal lymph nodes](https://durgical.com/en/anatomy/parasternal-nodes/)

## How to find it

Not palpable; they follow the internal thoracic artery about a finger-breadth from the sternal edge and are seen beside it on contrast CT and on ultrasound.

## On imaging

Seen on contrast CT beside the artery, behind the costal cartilages next to the [sternum](https://durgical.com/en/anatomy/sternum/); along this line internal mammary nodes are looked for in breast cancer staging. In [superior vena cava](https://durgical.com/en/anatomy/superior-vena-cava/) obstruction CT shows them and the chest-wall veins enlarged as collaterals. Before free-flap breast reconstruction, CT angiography or Doppler checks their size.

## Common problems

- Rarely diseased.

## Treatment

- In bypass surgery the left internal mammary artery is freed and joined to the LAD; it often stays open for decades.

## Clinical notes

- Taken with the artery in a pedicled coronary graft, or left in place in a skeletonized harvest
- Bleeding from them or from side branches is one source of bleeding after a sternotomy
- They dilate, with the chest-wall veins, in superior vena cava obstruction

## Test yourself

Think of the answer, then tap the question to see it.

## Into which vein do the internal thoracic veins drain?

The brachiocephalic vein of the same side, after the two veins beside the artery merge into one vein medial to it.

## How do the internal thoracic veins link the superior and inferior vena cava systems?

Through the superior and inferior epigastric veins, a collateral path that enlarges when either cava is blocked.

## In which reconstructive operation are the internal thoracic veins the recipient veins of choice?

Free-flap breast reconstruction, together with the internal thoracic artery.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
venae thoracicae internae TA2 4786

**Official Spanish (DeCS)**
Venas torácicas internas

**English (TA2)**
Internal thoracic veins

**Also called**
vena mammaria interna

Sources: Terminologia Anatomica (TA2); [Anatomy, Thorax, Internal Mammary (Internal Thoracic) Arteries](https://www.ncbi.nlm.nih.gov/books/NBK537337/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/internal-thoracic-veins/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/internal-thoracic-veins/