Anatomy and diseases of the superior vena cava. superior vena cava

Superior vena cava - short vessel 5-8 cm long and 21-25 mm wide. It is formed by the confluence of the right and left brachiocephalic veins. The superior vena cava receives blood from the walls of the chest and abdominal cavities, the organs of the head and neck, upper limbs.

Veins of the head and neck. The main venous collector from the organs of the head and neck is the internal jugular vein and partially the external jugular vein (Fig. 94).

Rice. 94. Veins of the head and face:

1 - occipital vein; 2 - pterygoid (venous) plexus; 3 - maxillary vein; 4 - submandibular vein; 5 - internal jugular vein; 6 - external jugular vein; 7 - mental vein; 8 - facial vein; 9 - frontal vein; 10- superficial temporal vein

Internal jugular vein - a large vessel that receives blood from the head and neck. It is a direct continuation of the sigmoid sinus of the dura mater; originates from the jugular foramen of the skull, goes down and, together with the common carotid artery and vagus nerve forms the neurovascular bundle of the neck. All tributaries of this vein are divided into intracranial and extracranial.

To intracranial include cerebral veins that collect blood from the cerebral hemispheres; meningeal veins - blood comes from the meninges; diploic veins - from the bones of the skull; eye veins - blood comes from the organs of vision and nose; labyrinth veins - from inner ear. These veins carry blood to the venous sinuses (sinuses) of the hard shell of the brain. The main sinuses of the dura mater are superior sagittal sinus, which runs along the upper edge of the falx cerebrum and flows into the transverse sinus; inferior sagittal sinus runs along the lower edge of the falx cerebrum and flows into the straight sinus; straight sine connects with the transverse; the cavernous sinus is located around the Turkish saddle; transverse sinus laterally enters the sigmoid sinus, which passes into the internal jugular vein.

Sinuses of the dura mater with emissary veins connect with the veins of the outer covering of the head.

To extracranial tributaries internal jugular vein are facial vein - collects blood from the face and oral cavity; submandibular vein - takes blood from the scalp, auricle, masticatory muscles, part of the face, nose, mandible.

The pharyngeal veins, lingual, and superior thyroid veins flow into the internal jugular vein in the neck. They collect blood from the walls of the pharynx, tongue, floor of the mouth, submandibular salivary glands, thyroid gland, larynx, sternocleidomastoid muscle.

External jugular vein formed as a result of the connection of its two tributaries: 1) the confluence of the occipital and posterior ear veins; 2) anastomosis with the submandibular vein. Collects blood from skin of occipital and behind ear area. The suprascapular vein, anterior jugular vein and transverse veins of the neck flow into the external jugular vein. These vessels collect blood from the skin of the same area.

Anterior jugular vein is formed from the small veins of the mental region, penetrates into the interfascial suprasternal space, in which the right and left anterior jugular veins, connecting, form jugular venous arch. The latter flows into the external jugular vein of the corresponding side.

subclavian vein - unpaired trunk, is a continuation of the axillary vein, merges with the internal jugular vein, collects blood from the upper limb.

Veins of the upper limb. Allocate superficial and deep veins of the upper limb. Superficial veins, connecting with each other, form venous networks, from which two main saphenous veins of the arm are then formed: lateral saphenous vein of the arm is on the side radius and empties into the axillary vein and medial saphenous vein of the arm located on the ulnar side and flows into the brachial vein. In the elbow bend, the lateral and medial saphenous veins are connected by a short intermediate vein of the elbow.

The deep veins of the upper limb are deep palmar veins. They accompany the arteries of the same name in two, form superficial and deep venous arches. The palmar digital and palmar metacarpal veins flow into the superficial and deep palmar venous arches, which then pass into the deep veins of the forearm - the paired ulnar and radial veins. Along the way, veins from muscles and bones join them, and in the region of the cubital fossa they form two brachial veins. The latter take blood from the skin and muscles of the shoulder, and then, not reaching the axillary region, at the level of the tendon of the widest muscle of the back, they are connected into one trunk - axillary vein. Veins flow into this vein from the muscles of the shoulder girdle and shoulder, and also partially from the muscles of the chest and back.

At the level of the outer edge of the 1st rib, the axillary vein passes into subclavian. It is joined by the non-permanent transverse vein of the neck, the subscapular vein, as well as the small thoracic and dorsal scapular veins. The confluence of the subclavian vein with the internal jugular vein on each side is called the venous angle. As a result of this connection, brachiocephalic veins, where the veins of the thymus, mediastinum, pericardial sac, esophagus, trachea, neck muscles flow, spinal cord etc. Further, having joined, the brachiocephalic veins form the main trunk - superior vena cava. It is joined by the veins of the mediastinum, the pericardial sac and unpaired vein, which is a continuation of the right ascending lumbar vein. The unpaired vein collects blood from the walls of the abdominal and chest cavities (Fig. 95). It empties into an unpaired vein semi-azygous vein, to which the veins of the esophagus, mediastinum, partially posterior intercostal veins join; they are a continuation of the left ascending lumbar vein.

Inferior vena cava system

The system of the inferior vena cava is formed from the joints that collect blood from the lower extremities, walls and organs of the pelvis and abdominal cavity.

inferior vena cava formed by the union of the left and right common iliac veins. This thickest venous trunk is located retroperitoneally. It originates at the level of the IV-V lumbar vertebrae, is located to the right of the abdominal aorta, goes up to the diaphragm and through the opening of the same name into the posterior mediastinum. Penetrates into the pericardial cavity and flows into the right atrium. Along the way, parietal and visceral vessels join the inferior vena cava.

Parietal venous tributaries include lumbar veins(3-4) on each side, collect blood from the venous plexus of the spine, muscles and skin of the back; anastomose with the ascending lumbar vein; inferior phrenic veins(right and left) - blood comes from the lower surface of the diaphragm; drain into the inferior vena cava.

The group of visceral tributaries includes testicular (ovarian) veins, collect blood from the testicle (ovary); renal veins - from the kidney; adrenal - from the adrenal glands; hepatic - carry blood away from the liver.

Venous blood from the lower extremities, walls and organs of the pelvis is collected in two large venous vessels: the internal iliac and external iliac veins, which, having joined at the level of the sacroiliac joint, form the common iliac vein. Both common iliac veins then merge into the inferior vena cava.

Internal iliac a vein is formed from veins that collect blood from the pelvic organs and belong to the parietal and visceral tributaries.

To the group parietal tributaries includes the superior and inferior gluteal veins, obturator, lateral sacral and iliac-lumbar veins. They collect blood from the muscles of the pelvis, thigh, and abdomen. All veins have valves. To visceral tributaries include the internal genital vein - collects blood from the perineum, external genital organs; bladder veins - blood comes from the bladder, vas deferens, seminal vesicles, prostate (in men), vagina (in women); lower and middle rectal veins - collect blood from the walls of the rectum. Visceral tributaries, connecting with each other, form around the pelvic organs ( bladder, prostate, rectum) venous plexus.

Vienna lower limb take aim into superficial and deep, which are interconnected by anastomoses.

In the area of the foot, the saphenous veins form the plantar and dorsal venous networks of the foot, into which the digital veins flow. From the venous networks, the dorsal metatarsal veins are formed, which give rise to the large and small saphenous veins of the leg.

Great saphenous vein of the leg is a continuation of the medial dorsal metatarsal vein, along the way it receives numerous superficial veins from the skin and flows into the femoral vein.

Small saphenous vein of the leg It is formed from the lateral part of the subcutaneous venous network of the rear of the foot, flows into the popliteal vein, collects blood from the saphenous veins of the plantar and dorsal surfaces of the foot.

Deep veins of the lower limb are formed by the digital veins, which merge into the plantar and dorsal metatarsal veins. The latter flow into the plantar and dorsal venous arches of the foot. From the plantar venous arch, blood flows through the plantar metatarsal veins into the posterior tibial veins. From the dorsal venous arch, blood enters the anterior tibial veins, which along the way collect blood from the surrounding muscles and bones and, when combined, form the popliteal vein.

Popliteal vein receives small knee veins, small saphenous vein and passes into the femoral vein.

femoral vein, rising up, goes under the inguinal ligament and passes into the external iliac vein.

The deep vein of the thigh flows into the femoral vein; veins surrounding femur; superficial epigastric veins; external genital veins; great saphenous vein of the leg. They collect blood from the muscles and fascia of the thigh and pelvic girdle, hip joint, lower part abdominal wall, external genitalia.

portal vein system

From unpaired organs of the abdominal cavity, except for the liver, blood is first collected in the portal vein system, through which it goes to the liver, and then through the hepatic veins to the inferior vena cava.

Portal vein(Fig. 96) - a large visceral vein (length 5-6 cm, diameter 11-18 mm), is formed by connecting the inferior and superior mesenteric and splenic veins. The veins of the stomach, small and large intestine, spleen, pancreas and gallbladder flow into the portal vein. Then the portal vein goes to the gate of the liver and enters its parenchyma. In the liver, the portal vein is divided into two branches: the right and the left, each of which, in turn, is divided into segmental and smaller ones. Inside the lobules of the liver, they branch into wide capillaries (sinusoids) and flow into the central veins, which pass into the sublobular veins. The latter, connecting, form three or four hepatic veins. Thus, blood from the organs of the digestive tract passes through the liver, and then only enters the system of the inferior vena cava.

Superior mesenteric vein goes to the roots of the mesentery small intestine. Its tributaries are the veins of the jejunum and ileum, pancreatic, pancreatoduodenal, iliac-colic, right gastroepiploic, right and middle colic veins and the vein of the appendix. The superior mesenteric vein receives blood from the above organs.

Rice. 96. Portal vein system:

1 - superior mesenteric vein; 2 - stomach; 3 - left gastroepiploic vein; 4 - left gastric vein; 5- spleen; 6- tail of the pancreas; 7- splenic vein; 8- inferior mesenteric vein; 9- descending colon; 10 - rectum; 11 - inferior rectal vein; 12- middle rectal vein; 13- superior rectal vein; 14 - ileum; 15 - ascending colon; 16 - head of the pancreas; 17, 23- right gastroepiploic vein; 18- portal vein; 19- gallbladder vein; 20 - gallbladder; 21 - duodenum; 22 - liver; 24- pyloric vein

splenic vein collects blood from the spleen, stomach, pancreas, duodenum and a large omentum. The tributaries of the splenic vein are the short gastric veins, the pancreatic vein, and the left gastroepiploic vein.

Inferior mesenteric vein is formed as a result of the confluence of the superior rectal vein, left colic and sigmoid veins; it collects blood from the walls of the upper rectum, sigmoid colon, and descending colon.

lymphatic system

The lymphatic system is part of cardio-vascular system(Fig. 97). Through the lymphatic system, water, proteins, fats, and metabolic products return from the tissues to the circulatory system.

Rice. 97. Lymphatic system (diagram):

1,2 - parotid lymphatic minds; 3 - cervical nodes; 4 - thoracic duct; 5, 14 - axillary lymph nodes; 6, 13 - elbow lymph nodes; 7, 9- inguinal lymph nodes; 8 - superficial lymphatic vessels shins; 10 - iliac nodes; 11 - mesenteric nodes; 12 - cistern of the thoracic duct; 15 - subclavian nodes; 16 - occipital nodes; 17- submandibular nodes

The lymphatic system performs a number of functions: 1) maintains the volume and composition of tissue fluid; 2) maintains a humoral connection between the tissue fluid of all organs and tissues; 3) absorption and transfer of nutrients from the digestive tract to the venous system; 4) transfer to the bone marrow and to the site of injury of migrating lymphocytes, plasma cells. Cells are transported through the lymphatic system malignant neoplasms(metastases), microorganisms.

The human lymphatic system consists of lymphatic vessels, lymph nodes and lymphatic ducts.

The beginning of the lymphatic system is lymph capillaries. They are found in all organs and tissues of the human body, except for the brain and spinal cord and their membranes, skin, placenta, spleen parenchyma. The walls of the capillaries are thin single-layer epithelial tubes with a diameter of 10 to 200 microns, have a blind end. They stretch easily and can expand 2-3 times.

When several capillaries merge, they form lymph vessel. Here is the first valve. Depending on the location of the lymphatic vessels are divided into superficial and deep. Through the vessels, lymph goes to the lymph nodes that correspond to a given organ or part of the body. Depending on where the lymph is collected from, visceral, somatic (parietal) and mixed lymph nodes are distinguished. The first collect lymph from internal organs(tracheobronchial, etc.); the second - from the musculoskeletal system (popliteal, elbow); still others - from the walls of hollow organs; the fourth - from the deep structures of the body (deep cervical nodes).

The vessels that carry lymph to the node are called bringing and the vessels that come out of the gates of the node - enduring lymphatic vessels.

Large lymphatic vessels form lymphatic trunks, which, when merged, form lymphatic ducts flowing into the venous nodes or into the terminal sections of the veins that form them.

There are six such large lymphatic ducts and trunks in the human body. Three of them (thoracic duct, left jugular and left subclavian trunks) flow into the left venous angle, three others (right lymphatic duct, right jugular and right subclavian trunks) into the right venous angle.

thoracic duct is formed in the abdominal cavity, behind the peritoneum, at the level of the XII thoracic and II lumbar vertebrae as a result of the fusion of the right and left lumbar lymphatic trunks. Its length is 20-40 cm, it collects lymph from the lower extremities, walls and organs of the pelvis, abdominal cavity and left half. chest. From the abdominal cavity, the thoracic duct passes through the aortic opening into the chest cavity, and then exits into the neck region and opens into the left venous angle or into the terminal sections of the veins that form it. It flows into the cervical part of the duct bronchomediastinal trunk, which collects lymph from the left half of the chest; left subclavian trunk carries lymph from the left hand; left jugular trunk comes from the left half of the head and neck. On the path of the thoracic duct there are 7-9 valves that prevent the reverse flow of lymph.

From the right half of the head, neck, upper limb, organs of the right half of the chest, lymph collects right lymphatic duct. It is formed from the right subclavian, right bronchomediastinal and jugular trunks and flows into the right venous angle.

Lymphatic vessels and nodes of the lower limb are divided into superficial and deep. Superficial vessels collect lymph from the skin subcutaneous tissue feet, legs and thighs. They drain into the superficial inguinal lymph nodes, which are below the inguinal ligament. In the same nodes, lymph flows from the anterior abdominal wall, gluteal region, external genitalia, perineum and part of the pelvic organs.

In the popliteal fossa are popliteal lymph nodes, which collect lymph from the skin of the foot, lower leg. The efferent ducts of these nodes empty into deep inguinal lymph nodes.

deep lymphatic vessels they collect lymph from the foot, lower leg into the popliteal lymph nodes, and from the thigh tissues into the deep inguinal nodes, the efferent vessels of which flow into the external iliac nodes.

Depending on the location pelvic lymph nodes divided into parietal and visceral. The first group includes external, internal and common iliac nodes, which collect lymph from the walls of the pelvis. Visceral lymph nodes in relation to the pelvic organs are periurinary, parauterine, paravaginal, pararectal and collect lymph from the corresponding organs.

The efferent vessels of the internal and external iliac nodes reach common iliac lymph nodes, from which the lymph goes to the lumbar nodes.

AT abdominal lymph nodes lymph is collected from the parietal and visceral lymph nodes and vessels of the abdominal cavity, lower back.

The efferent lymphatic vessels of the lumbar lymph nodes form the right and left lumbar trunks, which give rise to the thoracic duct.

Lymphatic vessels and nodes of the chest cavity collect lymph from the walls of the chest and organs located in it.

Depending on the topography of organs, lymph nodes are distinguished parietal(sternal, intercostal, superior diaphragmatic) and visceral(anterior and posterior mediastinal, bronchopulmonary, lower and upper tracheobronchial). They collect lymph from the relevant organs.

In the head area, lymph flows from the occipital, mastoid, superficial and deep parotid, facial, chin, submandibular lymph nodes.

By topographic location neck lymph nodes are divided into cervical and lateral cervical, as well as superficial and deep. Lymph comes to them from adjacent organs.

Connected, the lymphatic vessels of the neck on each side form jugular trunk. On the right, the jugular trunk joins the right lymphatic duct or independently flows into the venous angle, and on the left - to the thoracic duct.

In the upper limb, the lymph first collects through the superficial and deep vessels into the regional elbow and axillary lymph nodes. They are in the pits of the same name. Elbow knots divided into superficial and deep. Axillary lymph nodes also divided into superficial and deep. By localization, the lymph nodes in the axillary region are divided into medial, lateral, posterior, lower, central and apical. Superficial lymphatic vessels, accompanying the saphenous veins of the upper extremities, form the medial, middle and lateral group.

Leaving the deep axillary lymph nodes, the vessels form the subclavian trunk, which flows into the thoracic duct on the left, and on the right into the right lymphatic duct.

The lymph nodes are peripheral organs immune system, which act as biological and mechanical filters and are usually located around blood vessels, usually in groups of several to ten knots or more.

Lymph nodes are pinkish-gray in color, round, ovoid, bean-shaped and ribbon-shaped, their length ranges from 0.5 to 30-50 mm (Fig. 98).

Rice. 98. The structure of the lymph node:

1 - capsule; 2 - trabecula; 3 - crossbar; 4 - cortex; 5 - follicles; 6- afferent lymphatic vessels; 7- medulla; 8- efferent lymphatic vessels; 9- gate of the lymph node

Each lymph node is covered with a connective tissue capsule from the outside. The lymph node on one side has veins and efferent lymphatic vessels. The afferent vessels approach the node from the convex side. Inside the node, thin partitions depart from the capsule and are interconnected in the depth of the node.

On the section of the node, peripheral dense cortical substance, which consists of cortical and paracortical zones, and the central medulla are visible. In the cortex and medulla, B- and T-lymphocytes are formed and a leukocyte factor is produced, which stimulates cell reproduction. Mature lymphocytes enter the sinuses of the nodes, and then are carried out with the lymph into the outlet vessels.

Hematopoietic organs

The bone marrow is the organ that produces blood cells. It forms and reproduces stem cells, which give rise to all types of blood cells and the immune system. Therefore, the bone marrow is also called the immune organ. Stem cells have a great ability to multiply and form a self-sustaining system.

As a result of numerous complex transformations and differentiation in three directions (erythropoiesis, granulopoiesis and thrombocytopoiesis), stem cells become formed elements. In stem cells, cells of the immune system are also formed - lymphocytes, and from the latter - plasma cells (plasmocytes).

Allocate red bone marrow, which is located in the spongy substance of flat and short bones, and yellow marrow, which fills the cavities of the diaphysis of long tubular bones.

total weight bone marrow an adult is about 2.5-3.0 kg, or 4.5-4.7% of body weight.

The red bone marrow consists of myeloid tissue, which also includes reticular and hematopoietic tissue, and yellow bone marrow consists of adipose tissue, which replaced the reticular tissue. With significant blood loss, the yellow bone marrow is again replaced by red bone marrow.

Spleen(lien, splen) performs the functions of a peripheral organ of the immune system. It is located in the abdominal cavity, in the region of the left hypochondrium, at the level from IX to XI ribs. The weight of the spleen is about 150-195 g, the length is 10-14 cm, the width is 6-10 cm and the thickness is 3-4 cm. splenic ligaments. It has a red-brown color, soft texture. Connective tissue partitions - trabeculae, between which there is a parenchyma, depart from the fibrous membrane inside the organ. The latter is formed by white and red pulp. The white pulp consists of splenic lymph nodes and lymphoid tissue around the intraorgan arteries. The red pulp is formed by loops of reticular tissue filled with erythrocytes, lymphocytes, macroorganisms and other cellular elements, as well as venous sinuses.

On the concave surface are the gates of the spleen, they are the vessels and nerves.

In the spleen, the destruction of erythrocytes occurs, as well as the differentiation of T- and B-lymphocytes.

thymus(thymus), or thymus, refers to the central organs of lymphocytopoiesis and immunogenesis. In the thymus, stem cells coming from the bone marrow. after a series of transformations, they become T-lymphocytes. The latter are responsible for the reactions cellular immunity. Then T-lymphocytes enter the blood and lymph, leave the thymus and pass into the thymus-dependent zones of the peripheral organs of immunogenesis. in the thymus epithelial cells stroma produce thymosin(hemopoietic factor), which stimulates the proliferation of lymphoblasts. In addition, other biologically active substances are produced in the thymus. active substances(factors with properties of insulin, calcitonin, growth factors).

The thymus is an unpaired organ, consisting of the left and right lobes connected by loose fiber. From above, the thymus gland narrows, and expands from below. The left lobe in many cases may be longer than the right.

The thymus is located in the anterior upper mediastinum, in front of the upper part of the pericardium, aortic arch, left brachiocephalic and superior vena cava. The right and left mediastinal pleura adjoin the thymus on the sides. The anterior surface of the thymus connects to the sternum. The organ is covered with a thin connective tissue capsule, from which partitions extend inward, dividing the substance of the gland into small lobules. The parenchyma of the organ consists of the peripheral part of the cortex and the central part of the medulla. The thymus stroma is represented by reticular tissue. Between the fibers and cells of the reticular tissue are thymus lymphocytes (thymocytes), as well as multi-layered epithelial cells (epithelio-reticulocytes). In addition to the immunological function and the function of blood formation, the thymus is also characterized by endocrine activity.

The circulatory system should be attributed to the most important component human body. The superior vena cava is an integral part of this system. Blood plays the role of a nutrient for our body, it takes part in all important metabolic reactions.

Human anatomy, as topography shows, includes vessels and veins in the circulatory system, through which important elements are delivered. For this reason, for the whole circuit to work perfectly, even a small capillary must perform its functions perfectly.

Only the heart matters

In order to find out what anatomy and topography of the heart, you need to study its structure a little. The human heart consists of 4 chambers, divided by a partition into 2 halves: right and left. Each half contains a ventricle and an atrium. Another separating element is the septum, which takes part in pumping blood.

The complex topography of the venous apparatus of the heart is due to four veins: two channels (the veins of the system of the superior vena cava) are directed to the area of the right atrium, at the same time two pulmonary ones flow into the left.

In addition, the circulatory system also includes the aorta and the pulmonary trunk. Through the aorta, branched from the mouth of the left ventricle, the blood flow enters the specified organs and tissues of the human body (except for the lungs). The blood path runs from the right ventricle to pulmonary artery through the pulmonary circulation, which nourishes the alveoli of the lung and bronchi. This is how blood circulates in our body.

Venous apparatus of the heart muscle

Since our heart has a fairly compact size, the vascular area also consists of small but thick-walled veins. In front of the mediastinum of the heart is a vein formed by the union of the left and right brachiocephalic veins. This vein is called the superior vena cava, it belongs to the systemic circulation. Its dimensions in diameter can be up to 23-25 mm, and in length from 4.8 to 7.5 cm.

As the topography indicates, the mouth of the superior vena cava is located at a sufficient depth in the pericardial cavity. On the left side of the vessel is the ascending aorta, and on the right side is the mediastinal pleura. At a small distance behind it, the anterior surface of the root section of the right lung is visible. Such a dense interposition threatens with compression, which leads to poor blood circulation.

The superior vena cava adjoins the right atrium at the level of the second rib and is filled with blood flow from the neck, head, upper chest and arms. This modest-sized blood vessel, no doubt, plays an important role in the life support of the human body.

What vessels make up the superior vena cava system? The veins that transport the blood flow are located in close proximity to the heart, therefore, when the heart chambers are relaxed, they are attracted to it. These repetitive movements create circulatory system strong negative pressure.

Vessels that form the system of the superior vena cava:

vessels involved in nourishing the neck and chest;
several veins stretching from the walls of the abdomen;
veins of the head and cervical region;
venous channels of the shoulder girdle and arms.

Mergers and Confluences

Intermediate topography indicates the existence of several tributaries of the superior vena cava. The main tributaries include the brachiocephalic veins (right and left), formed as a result of the confluence of the subclavian and internal jugular veins. They do not have valves, since the constant low pressure increases the risk of injury if air enters.

The route of the left brachiocephalic vein lies behind the thymus and the manubrium of the sternum, and immediately behind it is the left carotid artery and the brachiocephalic trunk. The path of the right blood thread of the same name runs from the sternoclavicular joint and passes to the upper zone of the right pleura.

In the case of congenital anomalies of the heart muscle, an additional left superior vena cava is formed. It can be safely considered an ineffective inflow, which does not exert any burden on hemodynamics.

Causes of compression

As mentioned above, the opening of the superior vena cava can be compressed. This disease is called superior vena cava syndrome.

Its course is characterized by the following pathological processes:

oncological diseases ( lung cancer, adenocarcinoma);
the stage of spread of metastases in breast cancer;
syphilis;
tuberculosis;
retrosternal goiter of the thyroid gland;
soft tissue type of sarcoma and others.

There are frequent cases when compression occurs due to dense germination malignant tumor to one of the sites on the vein wall or due to its metastasis. Thrombosis of the superior vena cava (as well as thrombophlebitis) can become a provoking factor, causing an increase in pressure in the lumen of the vessel up to 250-500 mm Hg, which threatens to damage (rupture) the vein and quickly kill the patient.

How does the syndrome manifest?

Symptoms of the syndrome can occur abruptly, without any provoking factors and precursors. This can occur at a time when the superior vena cava is tightly blocked by an atherosclerotic thrombus.

In most cases, the onset of the syndrome is characterized by the following symptoms:

cough with increasing dyspnea effect;
attacks of headache and dizziness;
pain syndrome with localization in the chest area;
dysphagia and nausea;
change in facial expressions, facial features;
fainting states;
noticeable swelling of the veins in the cervical region and within the chest;
swelling and puffiness of the face;
cyanosis of the facial area or chest.

For the most accurate diagnosis of the syndrome of the superior vena cava, it is necessary to undergo a series of procedures aimed at examining the condition of the venous channels. Such examinations include topography, radiography and Doppler ultrasound. Having resorted to their help, it is quite possible to differentiate diagnoses and prescribe the most effective surgical treatment.

In case of deterioration of general well-being, if the above symptoms are detected, you should immediately contact the medical institution for qualified advice. Only an experienced specialist will be able to establish the diagnosis most accurately and quickly, as well as suggest appropriate treatment measures.

If thrombosis of the superior vena cava is not detected in time, deplorable health conditions can occur.

The superior vena cava is a short thin-walled vein with a diameter of 20 to 25 mm, located in anterior mediastinum. Its length varies on average from five to eight centimeters. The superior vena cava is a vein great circle blood circulation and is formed by the confluence of two (left and right) brachiocephalic veins. It collects venous blood from the head, upper chest, neck, and arms and empties into the right atrium. The only tributary of the superior vena cava is the azygos vein. Unlike many other veins, this vessel does not have valves.

The superior vena cava is directed downward and enters the pericardial cavity at the level of the second rib, and a little lower flows into the right atrium.

The superior vena cava is surrounded by:

Left - aorta (ascending part);
Right - mediastinal pleura;
Ahead - the thymus (thymus gland) and the right lung (mediastinal part, covered with pleura);
Behind - the root of the right lung (anterior surface).

Superior vena cava system

All vessels included in the system of the superior vena cava are located close enough to the heart, and during relaxation, they are under the influence of the suction action of its chambers. Also affects them during respiratory movements rib cage. Due to these factors, a sufficiently strong negative pressure is created in the system of the superior vena cava.

The main tributaries of the superior vena cava are the avalvular brachiocephalic veins. They also always have very low pressure, so there is a risk of air entering if they are injured.

The system of the superior vena cava is made up of veins:

Neck and head areas;
The chest wall, as well as some veins of the abdominal walls;
Upper shoulder girdle and upper limbs.

Venous blood from the chest wall enters the inflow of the superior vena cava - the unpaired vein, which absorbs blood from the intercostal veins. The unpaired vein has two valves located at its mouths.

The external jugular vein is located at the level of the angle of the mandible under auricle. This vein collects blood from tissues and organs located in the head and neck. The posterior ear, occipital, suprascapular and anterior jugular veins flow into the external jugular vein.

The internal jugular vein originates near the jugular foramen of the skull. This vein, together with the vagus nerve and the common carotid artery, forms a bundle of vessels and nerves of the neck, and also includes the veins of the brain, meningeal, ophthalmic, and diploic veins.

Vertebral venous plexuses, which are part of the superior vena cava system, are divided into internal (passing inside the spinal canal) and external (located on the surface of the vertebral bodies).

Syndrome of compression of the superior vena cava

The syndrome of compression of the superior vena cava, manifested as a violation of its patency, can develop for several reasons:

With the progression of the development of oncological diseases. With lung cancer and lymphomas, lymph nodes are often affected, in the immediate vicinity of which the superior vena cava passes. Also, metastases of breast cancer, soft tissue sarcomas, melanoma can lead to impaired patency;
Against the background of cardiovascular insufficiency;
With the development of retrosternal goiter against the background of the pathology of the thyroid gland;
With the progression of some infectious diseases such as syphilis, tuberculosis and histioplasmosis;
In the presence of iatrogenic factors;
With idiopathic fibrous mediastinitis.

The syndrome of compression of the superior vena cava, depending on the causes that caused it, can progress gradually or develop quite quickly. The main symptoms of the development of this syndrome include:

swelling of the face;
Cough;
convulsive syndrome;
Headache;
nausea;
Dizziness;
Dysphagia;
Change in facial features;
Drowsiness;
Shortness of breath
fainting;
Pain in the chest;
Swelling of the veins of the chest, and in some cases of the neck and upper limbs;
Cyanosis and plethora of the upper chest and face.

To diagnose the syndrome of compression of the superior vena cava, as a rule, an x-ray is performed, which allows to identify the pathological focus, as well as to determine the boundaries and extent of its spread. In addition, in some cases, carry out:

Computed tomography - to obtain more accurate data on the location of the mediastinal organs;
Phlebography - to assess the extent of the focus of the violation and conduct differential diagnosis between vascular and extravascular lesions.

After the studies, taking into account the rate of progression of the pathological process, the issue of conducting drug treatment, chemo or radiotherapy or operations.

In cases where the cause of changes in the vein is thrombosis, thrombolytic therapy is carried out, followed by the appointment of anticoagulants (for example, heparin sodium or therapeutic doses of warfarin).

superior vena cava (v. cava superior) collects blood from the veins of the head, neck, both upper limbs, veins of the chest and partially abdominal cavities and flows into the right atrium. The azygous vein flows into the superior vena cava on the right, and the mediastinal and pericardial veins on the left. Has no valves.

Unpaired vein (v. azygos) is a continuation of the right ascending lumbar vein into the chest cavity (v. lumbalis ascendens dextra), has two valves at the mouth. The semi-azygous vein, esophageal veins, mediastinal and pericardial veins, posterior intercostal veins IV-XI and the right superior intercostal vein flow into the unpaired vein.

Semi-unpaired vein (v. hemiazygos) is a continuation of the left ascending lumbar vein (v. lumbalis ascendens sinistra). The mediastinal and esophageal veins flow into the semi-azygous vein, the accessory semi-azygous vein (v. hemiazygos accessoria), which receives I-VII superior intercostal veins, posterior intercostal veins.

Posterior intercostal veins (vv. intercostals posteriores) collect blood from the tissues of the walls of the chest cavity and part of the abdominal wall. Intervertebral vein drains into each posterior intercostal vein (v. intervertebralis), into which, in turn, the spinal branches flow (rr. spinales) and back vein (v. dorsalis).

Into the internal anterior and posterior vertebral venous plexuses (plexus venosi vertebrales interni) the veins of the cancellous substance of the vertebrae and the spinal veins drain. Blood from these plexuses flows into the accessory semi-unpaired and unpaired veins, as well as into the external anterior and posterior vertebral venous plexuses. (plexus venosi vertebrales externi), from which blood flows into the lumbar, sacral and intercostal veins and into the additional semi-unpaired and unpaired veins.

Right and left brachiocephalic veins (vv. brachiocephalicae dextra et sinistra) are the roots of the superior vena cava. They do not have valves. Collect blood from the upper extremities, organs of the head and neck, upper intercostal spaces. The brachiocephalic veins are formed by the confluence of the internal jugular and subclavian veins.

deep jugular vein (v. cervicalis profunda) originates from the external vertebral plexuses and collects blood from the muscles and the auxiliary apparatus of the muscles of the occipital region.

vertebral vein (v vertebralis) accompanies the artery of the same name, receiving blood from the internal vertebral plexuses.

Internal thoracic vein (v. thoracica interna) accompanies the artery of the same name on each side. It empties into the anterior intercostal veins (vv. intercostals anteriores), and the roots of the internal thoracic vein are the musculophrenic vein (v. muscleophrenica) and superior epigastric vein (v. epigastrica superior).

13. Veins of the head and neck

Internal jugular vein (v. jugularis interna) is a continuation of the sigmoid sinus of the dura mater of the brain, has in primary department upper bulb (bulbus superior); above the confluence with the subclavian vein is the lower bulb (bulbus inferior). There is one valve each above and below the lower bulb. The intracranial tributaries of the internal jugular vein are the ophthalmic veins. (vv. ophthalmicae superior et inferior), labyrinth veins (vv. labyrinthi) and diploic veins.

Through the diploic veinsvv. diploicae) - posterior temporal diploic vein (v. diploica temporalis posterior), anterior temporal diploic vein (v. diploica temporalis anterior), frontal diploic vein (v. diploica) and occipital diploic vein (v. diploica occipitalis) - blood flows from the bones of the skull; do not have valves. With the help of emissary veins (vv. emissariae) - mastoid emissary vein (v. emissaria mastoidea), condylar emissary vein (v. emissaria condylaris) and parietal emissary vein (v emissaria parietalis) - diploic veins communicate with the veins of the outer integument of the head.

Extracranial tributaries of the internal jugular vein:

1) lingual vein (v. lingualis), which is formed by the deep vein of the tongue, the hyoid vein, the dorsal veins of the tongue;

2) facial vein (v. facialis);

3) superior thyroid vein (v. thyroidea superior); has valves;

4) pharyngeal veins (vv. pharyngeales);

5) submandibular vein (v. retromandibularis).External jugular vein (v. jugularis externa) has paired

valves at the level of the mouth and middle of the neck. The transverse veins of the neck drain into this vein. (vv. transversae colli), anterior jugular vein (v. jugularis anterior), suprascapular vein (v. suprascapularis).

subclavian vein (v. subclavia) unpaired, is a continuation of the axillary vein.

superior vena cava does not have valves; collects blood from the head and neck, upper limbs, chest and abdominal (partially) cavities. The superior vena cava is formed by the confluence of the right and left brachiocephalic veins behind the junction of the first right rib with the sternum. The vein goes straight down. At the level of connection of the third costal cartilage with the sternum, the superior vena cava flows into the right atrium. Slightly above the confluence of the superior vena cava into the right atrium, an unpaired vein opens into it on the right, and on the left several pericardial veins and small mediastinal veins (from the connective tissue and lymph nodes of the mediastinum).

Superior vena cava and its tributaries. Formation of the superior vena cava and inferior vena cava. Veins of the posterior wall of the body. Front view. The parietal sheets of the pleura and peritoneum are removed. (-internal jugular vein; 2-left brachiocephalic vein "3-aortic arch; 4-esophagus (cut off); 5-hemisparous vein; 6-left ascending lumbar vein; 7-left common iliac vein; 8-left internal iliac vein; 9-left external iliac vein; IO-right external iliac vein; 11-right internal iliac vein; 12-median sacral vein; 13-inferior vena cava; 14-right ascending lumbar vein; 15-lumbar veins; 16-unpaired vein; 17-posterior intercostal veins; 18-superior vena cava; 19-right brachiocephalic vein; 20-brachial trunk; 21-right subclavian vein; 22-right external jugular vein; 23-right internal jugular vein.

Unpaired vein collects blood from the walls of the chest and abdominal cavities, as well as from the organs of the posterior mediastinum. The unpaired vein begins from the right ascending lumbar vein, which is a continuation of the anterior sacral veins. In the abdominal cavity, the right ascending lumbar vein anastomoses with the right lumbar veins, which empty into the inferior vena cava.

9 lower right intercostal veins flow into the unpaired vein, the right upper intercostal vein, which is formed from the three upper right intercostal veins. The esophageal, bronchial, pericardial and mediastinal veins also flow into the unpaired vein. A large tributary of the unpaired vein is the semi-unpaired vein.

Semi-unpaired vein originates from the left ascending lumbar vein, originating in the pelvis from the anterior sacral veins. The left ascending lumbar vein anastomoses with the left lumbar veins (tributaries of the inferior vena cava). After passing through the diaphragm, the left ascending lumbar vein passes into the semi-unpaired vein. The semi-unpaired vein goes up, then forms a bend to the right, passes behind the aorta, esophagus and thoracic duct and flows into the unpaired vein at the level of the VIII thoracic vertebra. The lower left posterior intercostal veins flow into the semi-unpaired vein, as well as the additional semi-unpaired vein, which is formed from 4-7 upper left posterior intercostal veins. The esophageal and posterior mediastinal veins drain into the semi-unpaired vein.

Posterior intercostal veins pass in the intercostal spaces, under the groove of the lower edge of the corresponding rib. The veins of the back (from the deep muscles of the back), the spinal veins, the veins of the external and internal vertebral plexuses flow into each posterior intercostal vein. Two or three lower posterior intercostal veins receive blood from the diaphragm and abdominal muscles.

Internal vertebral venous plexus located in the spinal canal, on the inner surface of its walls, outward from the dura mater throughout the spinal column. In the veins of this plexus, blood flows from the spinal column, spinal cord and its membranes.

External vertebral venous plexus located on the surfaces of the vertebral bodies and on the deep muscles of the neck. The veins of the deep muscles of the neck, the veins of the vertebral bodies flow into it. From the external vertebral plexuses, blood flows into the posterior intercostal, lumbar, sacral veins and directly into the unpaired and semi-unpaired veins.

Brachiocephalic veins are formed by the confluence of the internal jugular and subclavian veins of their side. The right and left brachiocephalic veins merge behind the junction of the first costal cartilage with the sternum to form the superior vena cava. The vertebral, deep cervical and internal thoracic veins flow into each brachiocephalic vein. The brachiocephalic vein also receives the pericardial, bronchial, esophageal, mediastinal, thymus, and inferior thyroid veins from the unpaired venous plexus located on the anterior surface of the thyroid gland. The highest (uppermost) intercostal vein also flows into the brachiocephalic vein, collecting blood from the upper 3-4 posterior intercostal veins.

The vertebral vein goes along with the artery of the same name in the canal of the transverse processes of the cervical vertebrae; collects blood from the venous plexuses located inside spinal canal, from the suboccipital venous plexus.

Deep vein of the neck is formed from the veins of the external vertebral plexus; removes blood from the deep veins of the occiput, vertebral plexus.

Internal thoracic veins two of them originate from the superior epigastric and musculophrenic veins. The superior epigastric vein drains blood from the rectus abdominis muscle, its vagina, anastomoses at the level of the umbilicus with the inferior epigastric vein (a tributary of the external iliac vein). The muscular-diaphragmatic vein goes up from the diaphragm, receives intercostal veins from the five lower intercostal spaces. The mediastinal veins from the pleura and mediastinal tissue, thymic veins also flow into the internal thoracic veins, bronchial veins coming from the lower trachea and the main bronchus of its side. The pericardial-phrenic vein flows into the internal thoracic veins. The internal thoracic vein also receives the sternal veins, veins of the mammary gland and the anterior intercostal veins.

On the right, the internal thoracic veins usually flow into the superior vena cava, on the left - into the left brachiocephalic vein.