Topics

Topic

design image
Superior epigastric veins

The superior epigastric veins are paired veins that accompany the superior epigastric arteries within the rectus sheath. They are located posterior to the rectus abdominis muscle and drain blood from the upper part of the anterior abdominal wall. Each vein ascends along the posterior surface of the rectus abdominis, enters the thorax, and drains into the internal thoracic vein, which then empties into the brachiocephalic vein.

The superior epigastric veins communicate inferiorly with the inferior epigastric veins, which drain into the external iliac vein. These communications create an important caval–caval anastomosis between the superior vena cava (SVC) and inferior vena cava (IVC), serving as collateral pathways in cases of venous obstruction.

Clinically, these veins are significant in portal hypertension (via portosystemic anastomoses), thoracoepigastric collateral circulation, and abdominal wall surgery. Enlarged superior epigastric veins may be seen in SVC obstruction, where they form visible abdominal wall collaterals.

Synonyms

  • Venae epigastricae superiores

  • Superior abdominal wall veins

  • Internal thoracic–abdominal venous channels

Function

  • Drain venous blood from the upper anterior abdominal wall

  • Connect with inferior epigastric veins to establish SVC–IVC collateral circulation

  • Provide venous pathways relevant in SVC syndrome and portal hypertension

  • Serve as landmarks in abdominal surgery and imaging

MRI Appearance

T1-weighted images:

  • Veins appear as tubular flow voids (dark lumen) posterior to rectus abdominis

  • Surrounded by hyperintense fat within rectus sheath

T2-weighted images:

  • Appear as signal voids against intermediate signal of muscle

  • Thrombosed veins may appear as intermediate-to-bright signal depending on clot age

STIR:

  • Fat suppression enhances visibility of the veins in the rectus sheath

  • Venous inflammation or edema in adjacent tissues appears hyperintense

T1 Fat-Saturated (Pre-contrast):

  • Lumen often shows intermediate signal intensity, standing out against suppressed fat background

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Veins enhance brightly and homogeneously in the venous phase

  • Useful for identifying patency, thrombosis, or collateral pathways

MRV (Magnetic Resonance Venography):

  • Demonstrates the course of superior epigastric veins within rectus sheath and their drainage into internal thoracic veins

  • Depicts caval–caval collateral pathways in cases of SVC or IVC obstruction

CT Appearance

CT Pre-Contrast:

  • Veins appear as linear soft-tissue structures posterior to rectus abdominis

  • Not well delineated without contrast

CT Post-Contrast:

  • Veins enhance and can be traced into internal thoracic veins

  • Detects thrombosis, varices, or enlarged collaterals

CTV (CT Venography):

  • Provides excellent 3D visualization of superior epigastric veins and their communication with inferior epigastric veins

  • Defines collateral venous pathways in SVC obstruction, portal hypertension, and surgical planning

MRI images

Right superior epigastric veins MRI coronal anatomy image -img-00000-00000

MRI images

Right superior epigastric veins MRI coronal anatomy image -img-00000-00000_00001

CT image

Superior epigastric veins CT AXIAL