Topics

Topic

design image
Thoracodorsal vein

The thoracodorsal vein is a major venous tributary of the axillary vein, accompanying the thoracodorsal artery and nerve as part of the thoracodorsal neurovascular bundle. It drains the latissimus dorsi muscle, portions of the serratus anterior, and overlying skin and subcutaneous tissue of the lateral thoracic wall.

The vein originates within the muscle and soft tissue planes of the back, joins with venae comitantes of the thoracodorsal artery, and ascends along the posterior axillary wall. It eventually empties into the subscapular vein, which drains into the axillary vein.

Anatomically, the thoracodorsal vein is of major surgical importance because it forms the venous outflow of the thoracodorsal vascular pedicle, frequently used in latissimus dorsi flap procedures for breast reconstruction, head and neck reconstruction, and chest wall coverage. Its patency and caliber are critical for microvascular anastomosis.

Synonyms

  • Vena thoracodorsalis

  • Venous component of thoracodorsal pedicle

  • Thoracodorsal venous pedicle

Function

  • Drains venous blood from the latissimus dorsi muscle, serratus anterior, and adjacent thoracic wall

  • Provides venous return through the subscapular → axillary → subclavian → brachiocephalic vein → SVC pathway

  • Acts as a reliable venous pedicle in reconstructive surgery

  • Serves as a landmark in axillary and thoracic surgery

Tributaries

  • Muscular venules of the latissimus dorsi

  • Small venous branches from the serratus anterior and intercostal spaces

  • Communicates with circumflex scapular and lateral thoracic veins

MRI Appearance

T1-weighted images:

  • Lumen appears as a signal void (black); vessel wall hypointense

  • Surrounded by fat in posterior axillary wall aiding detection

T2-weighted images:

  • Flowing venous blood produces a signal void

  • Thrombus within vein appears as intermediate to high signal depending on stage

STIR:

  • Suppresses fat, highlighting the vein within axillary soft tissue planes

  • Helps detect perivascular edema, thrombosis, or inflammation

T1 Post-Gadolinium (Gd-enhanced MRI):

  • Thoracodorsal vein enhances brightly and homogeneously

  • Clearly shows venous caliber and confluence with subscapular vein

  • Filling defects correspond to thrombosis or surgical ligation

MRA (MR Venography):

  • Contrast-enhanced venography demonstrates the thoracodorsal → subscapular → axillary venous pathway

  • Useful for preoperative flap planning and venous patency assessment

CT Appearance

CT Post-Contrast (CT Venography):

  • Vein opacifies with contrast, seen as a small tubular enhancing structure along thoracodorsal artery and nerve in axillary wall

  • Multiplanar reformats outline its confluence into the subscapular vein

  • Critical for evaluating surgical planning, venous thrombosis, or post-operative complications in flap surgery

  • Differentiates from lymph nodes or soft tissue masses in axilla

CT image

Thoracodorsal vein CT axial image -img-00000-00000