anterior vena cava
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The superior vena cava (SVC) is the superior of the two
venae cavae In anatomy, the venae cavae (; singular: vena cava ; ) are two large veins (great vessels) that return deoxygenated blood from the body into the heart. In humans they are the superior vena cava and the inferior vena cava, and both empty into the ...
, the great
venous Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated ...
trunks that return deoxygenated
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
from the systemic circulation to the
right atrium The atrium ( la, ātrium, , entry hall) is one of two upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the heart ventricles through the atrioventricular valves. There are two at ...
of the
heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...
. It is a large-diameter (24 mm) short length vein that receives venous return from the upper half of the body, above the diaphragm. Venous return from the lower half, below the diaphragm, flows through the
inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of th ...
. The SVC is located in the anterior right superior mediastinum. It is the typical site of central venous access via a
central venous catheter A central venous catheter (CVC), also known as a central line(c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centra ...
or a
peripherally inserted central catheter A peripherally inserted central catheter (PICC or PIC line), less commonly called a percutaneous indwelling central catheter, is a form of intravenous access that can be used for a prolonged period of time (e.g., for long chemotherapy regimens ...
. Mentions of "the cava" without further specification usually refer to the SVC.


Structure

The superior vena cava is formed by the left and right
brachiocephalic veins The left and right brachiocephalic veins (previously called innominate veins) are major veins in the upper chest, formed by the union of each corresponding internal jugular vein and subclavian vein. This is at the level of the sternoclavicular j ...
, which receive blood from the
upper limb The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shou ...
s, head and neck, behind the lower border of the first right
costal cartilage The costal cartilages are bars of hyaline cartilage that serve to prolong the ribs forward and contribute to the elasticity of the walls of the thorax. Costal cartilage is only found at the anterior ends of the ribs, providing medial extension. ...
. It passes vertically downwards behind first intercostal space and receives
azygos vein The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blo ...
just before it pierces the fibrous
pericardium The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong connective tissue (fibrous pericardium), and an inner layer made o ...
opposite right second costal cartilage and its lower part is intrapericardial. And then, it ends in the upper and posterior part of the sinus venarum of the right atrium, at the upper right front portion of the heart. It is also known as the cranial vena cava in other animals. No
valve A valve is a device or natural object that regulates, directs or controls the flow of a fluid (gases, liquids, fluidized solids, or slurries) by opening, closing, or partially obstructing various passageways. Valves are technically fitting ...
divides the superior vena cava from the right atrium. The superior vena cava is made up of three layers, starting with the innermost endothelial tunica intima. The middle layer is the tunica media, composed of smooth muscle tissue, and the outermost and thickest layer is the tunica adventitia, composed of collagen and elastic connective tissue that allow for flexibility. The tunica adventitia contains three zones, with the middle zone consisting of few smooth muscle fibers; this differs from the longitudinal bundles of smooth muscle found in the same zone of the inferior vena cava.


Anatomical variation

The most common
anatomical variation An anatomical variation, anatomical variant, or anatomical variability is a presentation of body structure with morphological features different from those that are typically described in the majority of individuals. Anatomical variations are categ ...
is a
persistent left superior vena cava In anatomy, a persistent left superior vena cava is the most common variation of the thoracic venous system. It is present in between 0.3% and 0.5% of the population, and is an embryologic remnant that results from a failure to involute. Presenta ...
. In persons with a persistent left superior vena cava, the right superior vena cava may be normal, small or absent, with or without an anterior communicating vein. This variation is present in less than 0.5% of the general population, but in up to 10% in patients with
congenital heart disease A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular ...
.


Clinical significance

Superior vena cava obstruction refers to a partial or complete obstruction of the superior vena cava, typically in the context of
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
such as a cancer of the lung,
metastatic cancer Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...
, or
lymphoma Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enla ...
. Obstruction can lead to enlarged veins in the head and neck, and may also cause breathlessness, cough, chest pain, and difficulty swallowing. Pemberton's sign may be positive. Tumours causing obstruction may be treated with
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...
and/or radiotherapy to reduce their effects, and corticosteroids may also be given. In
tricuspid valve The tricuspid valve, or right atrioventricular valve, is on the right dorsal side of the mammalian heart, at the superior portion of the right ventricle. The function of the valve is to allow blood to flow from the right atrium to the right ven ...
regurgitation, these pulsations are very strong. No
valve A valve is a device or natural object that regulates, directs or controls the flow of a fluid (gases, liquids, fluidized solids, or slurries) by opening, closing, or partially obstructing various passageways. Valves are technically fitting ...
divides the superior vena cava from the right atrium. As a result, the (right) atrial and (right) ventricular contractions are conducted up into the
internal jugular vein The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. It begins in the poste ...
and, through the
sternocleidomastoid muscle The sternocleidomastoid muscle is one of the largest and most superficial cervical muscles. The primary actions of the muscle are rotation of the head to the opposite side and flexion of the neck. The sternocleidomastoid is innervated by the access ...
, can be seen as the jugular venous pressure.


Additional images

File:Gray490.png, The thorax, viewed from the front, showing the superior vena cava between the heart and lungs. File:Gray494.png, Heart seen from above, with the valve-less entry of the superior vena cava visible on the right. File:Slide1eeee.JPG, Superior vena cava in a cadaveric specimen. File:Gray503.png, Cross-section of the thorax showing the formation of the superior vena cava.


See also

* Persistent left superior vena cava * Superior vena cava syndrome *
Inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of th ...


References

{{DEFAULTSORT:Superior Vena Cava Veins of the torso