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The left superior intercostal vein drains the posterolateral part of the left second, third and occasionally the fourth intercostal spaces. Tributaries from each interspace merge near the lateral surface of the third vertebral body before passing anteriorly through the mediastinum. It passes anterolateral to the arch of the aorta intermediate to the left phrenic and left vagus nerves. Finally, it merges with the inferior surface of the mid-section of the left brachiocephalic vein.
Occasionally, the vein may follow a different course e.g. merging with the accessory hemiazygous vein.
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