supreme intercostal vein

The supreme intercostal vein, also called the highest intercostal vein, is a small vein that drains blood from the first intercostal space and empties into the superior intercostal vein.

The supreme intercostal vein drains into the superior intercostal vein, which in turn drains into the brachiocephalic vein on the left side or the azygos/hemiazygos system on the right. It is described as a tributary of the superior intercostal vein.

The first intercostal space is the space between the first and second ribs. The supreme intercostal vein collects venous blood from the muscles, pleura, and other soft tissues within this space, running alongside the first posterior intercostal artery.

The superior intercostal vein typically drains the second and third intercostal spaces, while the supreme intercostal vein specifically drains the first intercostal space and is a tributary feeding into the superior intercostal vein. The supreme intercostal vein is smaller and more cranially positioned.

Understanding the venous drainage of the upper chest is important in thoracic surgery, central venous catheter placement, and interpretation of chest imaging. Anomalies or enlargement of the superior intercostal veins can appear on chest radiographs or CT scans as the 'aortic nipple' sign, and may indicate venous obstruction or anomalous drainage.