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Superior epigastric artery

The superior epigastric artery is the terminal branch of the internal thoracic artery, descending into the anterior abdominal wall. It arises at the level of the sixth costal cartilage, passes posterior to the rectus abdominis muscle, and runs within the rectus sheath. Along its course, it anastomoses with the inferior epigastric artery (branch of external iliac artery) at the level of the umbilicus, forming an important collateral pathway between the subclavian and external iliac arterial systems.

It supplies the rectus abdominis muscle, anterior abdominal wall, diaphragm, peritoneum, and superior abdominal skin. Clinically, this artery is significant in abdominal wall reconstructions (e.g., TRAM flaps), trauma, hernia repair, and collateral circulation in aortoiliac occlusive disease.

Synonyms

  • Arteria epigastrica superior

  • Terminal branch of internal thoracic artery

Function

  • Supplies the rectus abdominis muscle and overlying skin of the upper abdominal wall

  • Contributes to the blood supply of the diaphragm and anterior peritoneum

  • Provides critical collateral circulation with inferior epigastric artery

  • Serves as a vascular pedicle in flap surgeries (e.g., TRAM flap for breast reconstruction)

Arterial Supply (Source)

  • Terminal branch of internal thoracic artery

Venous Drainage

  • Superior epigastric vein → internal thoracic vein → brachiocephalic vein

MRI Appearance

T1-weighted images:

  • Appears as a linear flow void (black lumen) along posterior rectus sheath

  • Surrounded by hyperintense abdominal wall fat planes

T2-weighted images:

  • Artery lumen shows a signal void

  • Pathology (aneurysm, thrombus) may appear hyperintense depending on blood flow/stasis

STIR:

  • Suppresses fat, improving artery visualization in abdominal wall

  • Detects perivascular edema or inflammatory changes

T1 Fat-Saturated (Pre-contrast):

  • Lumen appears intermediate signal intensity, standing out against suppressed fat

  • Useful for differentiating vessel from fat and adjacent soft tissues

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Artery enhances brightly and homogeneously

  • Demonstrates vascular course, anastomosis with inferior epigastric artery, and pathology (stenosis, neovascularity, tumor feeders)

MRA (Magnetic Resonance Angiography):

  • Depicts origin from internal thoracic artery, course along rectus sheath, and anastomosis with inferior epigastric artery

  • Valuable in vascular mapping, flap surgery planning, and collateral circulation assessment

CT Appearance

CT Pre-Contrast:

  • Appears as a small tubular soft-tissue density in the rectus sheath, difficult to separate from muscle and fat

  • Can reveal vascular calcification if present

CT Post-Contrast:

  • Enhances brightly along posterior rectus sheath

  • Identifies arterial injury, hematoma, pseudoaneurysm, or tumor supply

CT Angiography (CTA):

  • Gold standard for defining the artery’s course and anastomotic network

  • Demonstrates collateral circulation between superior and inferior epigastric arteries

  • Essential for preoperative surgical planning (flaps, hernia repair), trauma, and vascular pathology

MRI images

Superior epigastric artery coronal anatomy image -img-00000-00000

MRI images

Superior epigastric artery coronal anatomy image -img-00000-00000_00001

CT imageS

Right superior epigastric artery CT AXIAL IMAGE

CT imageS

Right superior epigastric artery CT CORONAL IMAGE