450 International Journal of Medical Science and Public Health | 2015 | Vol 4 | Issue 4 Research Article Access this article online Website: http://www.ijmsph.com Quick Response Code: DOI: 10.5455/ijmsph.2015.1411201492 Vertebral levels of great vessels in mediastinum and their role in vascular interventions Naziya P Syed 1 , Althaf S Ali 2 , Imran S Syed 3 , Pritha SS Bhuiyan 4 1 Department of Anatomy, Deccan College of Medical Sciences, Hyderabad, Telangana, India. 2 Department of Radiology, Deccan College of Medical Sciences, Hyderabad, Telangana, India. 3 Department of Anatomy, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India. 4 Department of Anatomy, Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India. Correspondence to: Naziya P Syed, E-mail: dr.naziya@yahoo.co.in Received November 14, 2014. Accepted December 3, 2014 anatomy and pathology. [2,3] CT has better spatial resolution and shorter imaging time than MRI, besides being less expen- sive and more widely available; thus, CT remains the best imaging modality to study the mediastinal vasculature. [4–7] Central venous catheter (CVC) insertion is a routine procedure in intensive care units (ICUs) to administer drugs or intravenous fuids and also to measure central venous pressure. [8–10] The CVC tip has been classically positioned in the lower third of the SVC, just above the superior vena cava– right atrium (SVC-RA) junction to prevent complications. [8–15] Placement of catheter tips above or near the cephalad origin of the SVC with the infusion of hypertonic or irritative solutions risks thrombosis from endothelial damage, embolism, and stenosis of the brachiocephalic veins or catheter erosion into the mediastinum leading to hydrothorax or hydromediasti- num. Improper positioning of CVC or misplacement with tip resting within the right atrium results in lethal right atrial perforation that can rapidly progress to cardiac tamponade and arrhythmias. [16–18] Background: The interventional procedures such as central venous catheterization demand better knowledge of anatomy of mediastinal vessels. The vertebral body provides a useful and radiographically visible landmark for accurate central catheter tip placement. Objective: To study the vertebral levels of formation and termination of superior vena cava (SVC) and the vertebral level of origin of brachiocephalic trunk, left common carotid artery, and left subclavian artery in Indian subjects, and to describe their role in vascular interventions. Materials and Methods: The CT chest images of 48 patients were studied and vertebral levels of earlier mentioned vessels were measured. Results: The vertebral level of formation of SVC was found to be at the level of T3, T4, and T5 in 22.91%, 62.50%, and 14.58% cases, respectively, whereas that of the termination of SVC was found to be at the level of T5, T6, T7, and T8 in 10.41%, 56.25%, 29.16%, and 4.16% cases, respectively. The left common carotid artery, left subclavian artery, and the brachiocephalic trunk were found at T3, T4, and T5 in 27.08%, 60.41%, and 12.50% cases, respectively. Conclusion: The comprehensive data of vertebral levels will help clinicians in understanding the vascular levels for diagnostic and therapeutic purposes, especially in Indian subjects. KEY WORDS: Superior vena cava, central venous catheter, catheter tip placement, mediastinal vasculature, Indian subjects Abstract Introduction The great vessels in mediastinum include the ascending, the descending, and the arch of aorta, left common carotid artery, left subclavian artery, brachiocephalic trunk, and superior vena cava (SVC). [1] The anatomy as seen in the cadaver does not always refect accurately the situation in life because formalin fxation causes tissue hardening and shrink- age. Here comes the role of imaging techniques such as CT and MRI that have the ability to depict in vivo cross-sectional