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Posterior circumflex humeral vein

The posterior circumflex humeral vein (PCHV) is a paired venous structure accompanying the posterior circumflex humeral artery around the surgical neck of the humerus. It plays a vital role in draining the deltoid region, shoulder joint, and adjacent muscles, forming an important tributary of the axillary vein.

It courses through the quadrangular space of the shoulder along with the artery, traveling posteriorly around the humerus beneath the deltoid muscle. Its large caliber and communication with adjacent veins make it clinically significant during trauma, surgical procedures, and imaging evaluations of the shoulder.

Synonyms

  • Posterior humeral circumflex vein

  • Circumflex vein of shoulder

  • Vein of the quadrangular space

Origin, Course, and Termination

  • Origin: Arises as venae comitantes accompanying the posterior circumflex humeral artery from the vascular network around the deltoid and shoulder joint capsule.

  • Course:

    • Passes posteriorly through the quadrangular space with the posterior circumflex humeral artery and the axillary nerve.

    • Winds around the surgical neck of the humerus, deep to the deltoid muscle.

    • Forms venous plexuses within the deltoid and teres minor regions.

  • Termination: Empties into the axillary vein posteriorly, near the lower border of the subscapularis or teres major muscle.

Relations

  • Anteriorly: Surgical neck of humerus

  • Posteriorly: Deltoid and teres minor muscles

  • Superiorly: Shoulder joint capsule and humeral head

  • Inferiorly: Teres major and long head of triceps brachii

  • Medially: Axillary vein and posterior wall of axilla

  • Laterally: Deltoid and proximal humerus

Tributaries

  • Deltoid venous branches draining the deltoid muscle

  • Acromial branches from the shoulder region

  • Venous channels from the infraspinatus and teres minor muscles

  • Small communicating veins connecting with the anterior circumflex humeral vein and cephalic vein

Venous Drainage

  • Drains into the axillary vein, which continues as the subclavian vein

  • Provides venous return from:

    • Deltoid region

    • Glenohumeral joint capsule

    • Posterior shoulder muscles (teres minor, triceps long head)

    • Posterior circumflex network connecting to superficial veins

Function

  • Venous drainage: Collects blood from the posterior and lateral shoulder regions.

  • Pressure regulation: Provides collateral drainage during limb movement and venous compression.

  • Temperature control: Contributes to superficial and deep venous anastomoses aiding thermoregulation in the shoulder region.

  • Clinical relevance: Serves as an important landmark in shoulder surgery and imaging of the quadrangular space.

Clinical Significance

  • Trauma: May be injured during proximal humeral fractures or shoulder dislocation, leading to hematoma or venous thrombosis.

  • Venous obstruction: Thrombosis or compression in the quadrangular space can cause venous engorgement or shoulder swelling.

  • Quadrangular space syndrome: Associated venous congestion may accompany axillary nerve entrapment.

  • Surgical importance: Vulnerable during deltoid-splitting or posterior shoulder approaches.

  • Imaging relevance: Important in assessing vascular injury, venous thrombosis, and shoulder masses on MRI or CT venography.

MRI Appearance

  • T1-weighted images:

    • Venous lumen: Low signal (dark) due to flowing blood.

    • Venous wall: Thin, low-to-intermediate signal outline.

    • Surrounding fat: Bright, delineating the vessel clearly within the quadrangular space.

    • Thrombosed segment: Intermediate-to-bright intraluminal signal replacing normal flow void.

  • T2-weighted images:

    • Flowing blood: Signal void (dark) due to fast flow.

    • Thrombosis or slow flow: Bright hyperintense signal within the lumen.

    • Wall thickening or inflammation: Slightly hyperintense rim enhancement.

    • Perivenous edema: Appears as bright hyperintensity in adjacent soft tissues.

  • STIR:

    • Normal vein: Intermediate-to-dark signal with surrounding bright fat.

    • Thrombosis or inflammation: Bright intraluminal or perivascular signal due to fluid or edema.

    • Excellent for identifying soft-tissue inflammation around the vein in trauma or infection.

  • Proton Density Fat-Saturated (PD FS):

    • Normal: Lumen dark with suppressed fat around it.

    • Thrombosed vein: Bright signal within lumen and thickened wall.

    • Perivenous reaction: Focal or diffuse hyperintensity indicating inflammation.

  • T1 Fat-Sat Post-Contrast:

    • Normal vein: Shows bright enhancement of lumen from contrast-filled blood.

    • Thrombosed vein: No enhancement of occluded segment; surrounding tissues may enhance.

    • Perivenous inflammation: Irregular rim or linear enhancement along venous wall.

    • Post-traumatic changes: Patchy enhancement in hematoma or fibrotic tissue adjacent to vein.

CT Appearance

Non-Contrast CT:

  • Normal vein: Soft-tissue density tubular structure along the posterior humeral neck.

  • Thrombosis: Appears as non-enhancing, slightly hyperdense intraluminal area.

  • Adjacent anatomy: Quadrangular space and deltoid clearly visualized.

  • Bone landmarks: Lies posterior to surgical neck of humerus, near teres minor insertion.

Post-Contrast CT (CT Venography):

  • Normal vein: Uniform enhancement; clearly seen looping around posterior humerus.

  • Thrombosis: Filling defect within enhanced lumen.

  • Collateral veins: May appear enlarged if chronic obstruction is present.

  • Post-traumatic hematoma or soft-tissue swelling: Seen as enhancing perivenous changes.

  • Useful for identifying vascular injury, venous occlusion, or extrinsic compression in shoulder trauma and tumors.

MRI images

Posterior circumflex humeral vein axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

CT images

Posterior circumflex humeral vein ct axial image