Classification of Pressure Gradient of Human Common Carotid Artery and Ascending Aorta on the Basis of Age and Gender
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Of the Pediatric Mediastinum
MRI of the Pediatric Mediastinum Dianna M. E. Bardo, MD Director of Body MR & Co-Director of the 3D Innovation Lab Disclosures Consultant & Speakers Bureau – honoraria Koninklijke Philips Healthcare N V Author – royalties Thieme Publishing Springer Publishing Mediastinum - Anatomy Superior Mediastinum thoracic inlet to thoracic plane thoracic plane to diaphragm Inferior Mediastinum lateral – pleural surface anterior – sternum posterior – vertebral bodies Mediastinum - Anatomy Anterior T4 Mediastinum pericardium to sternum Middle Mediastinum pericardial sac Posterior Mediastinum vertebral bodies to pericardium lateral – pleural surface superior – thoracic inlet inferior - diaphragm Mediastinum – MR Challenges Motion Cardiac ECG – gating/triggering Breathing Respiratory navigation Artifacts Intubation – LMA Surgical / Interventional materials Mediastinum – MR Sequences ECG gated/triggered sequences SSFP – black blood SE – IR – GRE Non- ECG gated/triggered sequences mDIXON (W, F, IP, OP), eTHRIVE, turbo SE, STIR, DWI Respiratory – triggered, radially acquired T2W MultiVane, BLADE, PROPELLER Mediastinum – MR Sequences MRA / MRV REACT – non Gd enhanced Gd enhanced sequences THRIVE, mDIXON, mDIXON XD Mediastinum – Contents Superior Mediastinum PVT Left BATTLE: Phrenic nerve Vagus nerve Structures at the level of the sternal angle Thoracic duct Left recurrent laryngeal nerve (not the right) CLAPTRAP Brachiocephalic veins Cardiac plexus Aortic arch (and its 3 branches) Ligamentum arteriosum Thymus Aortic arch (inner concavity) Trachea Pulmonary -
Penetrating Carotid Artery: Uncommon Complex and Lethal Injuries
Eur J Trauma Emerg Surg (2011) 37:429–437 DOI 10.1007/s00068-011-0132-3 REVIEW ARTICLE Penetrating carotid artery: uncommon complex and lethal injuries J. A. Asensio • T. Vu • F. N. Mazzini • F. Herrerias • G. D. Pust • J. Sciarretta • J. Chandler • J. M. Verde • P. Menendez • J. M. Sanchez • P. Petrone • C. Marini Received: 16 June 2011 / Accepted: 19 June 2011 / Published online: 15 July 2011 Ó Springer-Verlag 2011 Abstract Carotid arterial injuries are the most difficult or occasionally via surgical cricothyroidotomy. Establish- and certainly the most immediately life-threatening injuries ing a surgical airway can be a difficult procedure given the found in penetrating neck trauma. Their propensity to bleed distortion of anatomic landmarks caused by hemorrhage. It actively and potentially occludes the airway and makes is also fraught with danger, as the incision may release the surgical intervention very challenging. Their potential for contained hematoma, resulting in torrential bleeding that causing fatal neurological outcomes demands that trauma can obscure the operative site and place the patient at risk surgeons exercise excellent judgment in the approach to for aspiration. These injuries incur high morbidity and their definitive management. The purpose of this article is mortality. Their neurologic sequelae can be devastating. to review the diagnosis and management of these injuries. Fortunately they are not common. Keywords Vascular Á Trauma Historical perspective Introduction The first documented case of the treatment of a cervical vascular injury is attributed to the French surgeon Ambrose Carotid arterial injuries are the most difficult and certainly Pare (1510–1590) [1], who was able to ligate the lacerated the most immediate life-threatening injuries found in carotid artery and a jugular vein of a wounded soldier. -
Vessels and Circulation
CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels. -
Thoracic Aorta
GUIDELINES AND STANDARDS Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging Endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance Steven A. Goldstein, MD, Co-Chair, Arturo Evangelista, MD, FESC, Co-Chair, Suhny Abbara, MD, Andrew Arai, MD, Federico M. Asch, MD, FASE, Luigi P. Badano, MD, PhD, FESC, Michael A. Bolen, MD, Heidi M. Connolly, MD, Hug Cuellar-Calabria, MD, Martin Czerny, MD, Richard B. Devereux, MD, Raimund A. Erbel, MD, FASE, FESC, Rossella Fattori, MD, Eric M. Isselbacher, MD, Joseph M. Lindsay, MD, Marti McCulloch, MBA, RDCS, FASE, Hector I. Michelena, MD, FASE, Christoph A. Nienaber, MD, FESC, Jae K. Oh, MD, FASE, Mauro Pepi, MD, FESC, Allen J. Taylor, MD, Jonathan W. Weinsaft, MD, Jose Luis Zamorano, MD, FESC, FASE, Contributing Editors: Harry Dietz, MD, Kim Eagle, MD, John Elefteriades, MD, Guillaume Jondeau, MD, PhD, FESC, Herve Rousseau, MD, PhD, and Marc Schepens, MD, Washington, District of Columbia; Barcelona and Madrid, Spain; Dallas and Houston, Texas; Bethesda and Baltimore, Maryland; Padua, Pesaro, and Milan, Italy; Cleveland, Ohio; Rochester, Minnesota; Zurich, Switzerland; New York, New York; Essen and Rostock, Germany; Boston, Massachusetts; Ann Arbor, Michigan; New Haven, Connecticut; Paris and Toulouse, France; and Brugge, Belgium (J Am Soc Echocardiogr 2015;28:119-82.) TABLE OF CONTENTS Preamble 121 B. How to Measure the Aorta 124 I. Anatomy and Physiology of the Aorta 121 1. Interface, Definitions, and Timing of Aortic Measure- A. The Normal Aorta and Reference Values 121 ments 124 1. -
The Variations of the Subclavian Artery and Its Branches Ahmet H
Okajimas Folia Anat. Jpn., 76(5): 255-262, December, 1999 The Variations of the Subclavian Artery and Its Branches By Ahmet H. YUCEL, Emine KIZILKANAT and CengizO. OZDEMIR Department of Anatomy, Faculty of Medicine, Cukurova University, 01330 Balcali, Adana Turkey -Received for Publication, June 19,1999- Key Words: Subclavian artery, Vertebral artery, Arterial variation Summary: This study reports important variations in branches of the subclavian artery in a singular cadaver. The origin of the left vertebral artery was from the aortic arch. On the right side, no thyrocervical trunk was found. The two branches which normally originate from the thyrocervical trunk had a different origin. The transverse cervical artery arose directly from the subclavian artery and suprascapular artery originated from the internal thoracic artery. This variation provides a short route for posterior scapular anastomoses. An awareness of this rare variation is important because this area is used for diagnostic and surgical procedures. The subclavian artery, the main artery of the The variations of the subclavian artery and its upper extremity, also gives off the branches which branches have a great importance both in blood supply the neck region. The right subclavian arises vessels surgery and in angiographic investigations. from the brachiocephalic trunk, the left from the aortic arch. Because of this, the first part of the right and left subclavian arteries differs both in the Subjects origin and length. The branches of the subclavian artery are vertebral artery, internal thoracic artery, This work is based on a dissection carried out in thyrocervical trunk, costocervical trunk and dorsal the Department of Anatomy in the Faculty of scapular artery. -
A RARE FINDING of THYROID IMA ARTERY ARISING from the AORTIC ARCH with IJCRR Section: Healthcare ABSENCE of LEFT INFERIOR THYROID ARTERY: a CASE REPORT
Case Report A RARE FINDING OF THYROID IMA ARTERY ARISING FROM THE AORTIC ARCH WITH IJCRR Section: Healthcare ABSENCE OF LEFT INFERIOR THYROID ARTERY: A CASE REPORT Takkallapalli Anitha Department of Anatomy, Chalmeda Anandrao Institute of Medical Sciences, Bommakal, Karimnagar, Andhra Pradesh, India. ABSTRACT An anomalous artery was seen arising from the arch of aorta and coursed upwards to the isthmus of thyroid gland. In the same cadaver, on further exposure of blood vessels supplying the thyroid gland, it is observed that the left inferior thyroid artery was absent. Though the incidence of thyroid ima artery arising from brachio cephalic trunk and subclavian artery was reported earlier, this is a rare finding where the artery arose from arch of aorta with absence of left inferior thyroid artery. Key Words: Blood supply of thyroid, Inferior thyroid artery, Arch of aorta INTRODUCTION ascending upwards to reach the isthmus of thyroid gland. On further exposure of thorax and tracing the ar- Arteria thyroidea ima is a small, inconstant but impor- tery to its origin, it was noticed that this slender artery tant artery of thyroid gland. In addition to thyroid, the arose from the upper margin of arch of aorta and coursed artery may also supply the thymus gland and neck vis- towards isthmus without giving any branches. On further cera [1]. It is present in 3% of cases and when present, it dissection to expose the blood vessels of thyroid gland, it emerges from brachio cephalic trunk, the arch of Aorta, is observed that the inferior thyroid artery on the left side the subclavian artery, right common carotid artery or in- was absent. -
Spontaneous Arteriovenous Malformations in the Cervical Area
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.33.3.303 on 1 June 1970. Downloaded from J. Neurol. Neurosurg. Psychiat., 1970, 33, 303-309 Spontaneous arteriovenous malformations in the cervical area J. GREENBERG, M.D. From the Department of Neurology, Episcopal Hospital, Philadelphia, Pennsylvania 19125, U.S.A. SUMMARY Four patients with spontaneous arteriovenous malformations of cervical vessels have been presented. The embryology of these vessels has been discussed in order to suggest an ex- planation for the apparent difference in the incidence of arteriovenous malformations involving the internal carotid artery and those involving either the vertebral or the external carotid arteries. A fifth case (S.T.) is presented as a probable iatrogenic arteriovenous fistula and is to be added to the steadily growing reports of this phenomenon. Trauma is the most common cause of arteriovenous had sustained a minor injury to the posterior aspect communications between the blood vessels in of the right ear. Routine skull films at the time did not the cervical area (Aronson, 1961). Iatrogenic reveal a fracture, and there was no evidence of local Protected by copyright. deep tissue injury noted. fistulae occurring after carotid or vertebral angio- On the present admission, a slight prominence of the graphy are being reported with regularity in the right retroauricular region was noted and a thrill and recent literature (Sutton, 1962). Spontaneous mal- bruit were present. The bruit could be obliterated by formations in this area also occur. Thus far, eight local pressure. cases have been reported involving the vertebral The neurological examination was within normal vessels (Norman, Schmidt, and Grow, 1950; limits. -
Surgical Indications. a Critical Point of View
Surgical indications in ascending aorta aneurysms: What do we know? Jean-Luc MONIN, MD, PhD. Institut Mutualiste Montsouris, Paris, FRANCE Disclosures related to this talk : www.imm.fr NONE 2 Clinical case www.imm.fr • A 40 year-old woman • Height: 172 cm/ Weight: 70 kg • Ascending aortic aneurysm • She wants to become pregnant (3-year old kid) • No Marfan syndrome or bicuspid AV • Younger sister: sudden unexplained death (at 18 years old) • 2012 (MRI): Valsalva: 42 mm, tubular: 43 mm • 2013 (MRI): Valsalva: 40 mm, tubular: 45 mm 3 www.imm.fr www.imm.fr www.imm.fr www.imm.fr www.imm.fr www.imm.fr What would we advise to this woman www.imm.fr ? A. Pregnancy is temporarily contra indicated, MRI or cardiac CT is needed B. No contra indication for pregnancy, TTE or MRI at 1 year 10 Thoracic aortic aneurysm www.imm.fr Thoracic Aortic Aneurysm: An indolent but virulent process www.imm.fr Ascending Aorta 1 mm/ year 45 mm 60 mm 3 mm/ year 34% Rate of aortic dilatation is EXPONENTIAL • Expansion rate ≈ 2.1 mm/ year for an initial diameter of 35-40 mm (%) rupture dissection/ of risk Lifetime Aortic diameter (cm) • Expansion rate ≈ 5.6 mm/ year for aneurysms ≥ 60 mm Coady et al. J Thorac Cardiovasc Surg. 1997;113: 476 Mechanical properties of human ascending aorta : >6 cm is the limit www.imm.fr Exponential relationship between wall stress and aneurysm size in ascending aortic aneurysms. • Pink columns : SBP =100 mm Hg • Purple columns : SBP = 200 mm Hg • Range of maximum tensile strength of the human aorta : 800 to 1,000 kPa Koullias et al. -
Study on Branching Pattern of Aortic Arch in Indian
Original Article http://dx.doi.org/10.5115/acb.2012.45.3.203 pISSN 2093-3665 eISSN 2093-3673 Study on branching pattern of aortic arch in Indian Sumit Tulshidas Patil, Meena M. Meshram, Namdeo Y. Kamdi, Arun P. Kasote, Madhukar P. Parchand Department of Anatomy, Government Medical College, Nagpur, Maharashtra, India Abstract: Knowledge of the branching pattern of aortic arch is important during supra-aortic angiography, aortic instrumentation, thoracic and neck surgery. The purpose of this study is to describe different branching pattern of arch of aorta in Indian subjects, in order to offer useful data to anatomists, radiologists, vascular surgeons while relating it to the embryological basis. Seventy five arches of adult Indian cadavers were exposed and their branches examined during cadaveric dissection in the Department of Anatomy, Government Medical College, Nagpur. The usual three-branched aortic arch was found in 58 cadavers (77.3%); the 11 (14.66%) remaining aortic arch showed only two branches, out of which one was a common trunk, which incorporated the brachiocephalic trunk and left common carotid and other left subclavian artery and 6 (8%) aortic arches showed direct arch origin of the left vertebral artery. Although the variations are usually asymptomatic, they may cause dyspnoea, dysphasia, intermittent claudication, misinterpretation of radiological examinations and complications during neck and thorax surgery. Knowledge of different patterns of arch of aorta is critical when invading the arch of aorta and its branches by instruments, as all these areas are delicate. Key words: Thoracic aorta, Variations, Branches, Vascular surgery Received March 28, 2012; Revised July 5, 2012; Accepted August 23, 2012 Introduction between them. -
Aorta and the Vasculature of the Thorax
Aorta and the Vasculature of the Thorax Ali Fırat Esmer, MD Ankara University Faculty of Medicine Department of Anatomy THE AORTA After originating from left ventricle, it ascends for a short distance, arches backward and to the left side, descends within the thorax on the left side of the vertebral column It is divided for purposes of The aorta is the main arterial trunk description into: that delivers oxygenated blood from Ascending aorta the left ventricle of the heart to the Arch of the aorta and tissues of the body. Descending aorta (thoracic and abdominal aorta) Ascending Aorta The ascending aorta begins at the base of the left ventricle runs upward and forward at the level of the sternal angle, where it becomes continuous with the arch of the aorta it possesses three bulges, the sinuses of the aorta Branches Right coronary artery Left coronary artery ARCH OF THE AORTA The aortic arch is a continuation of the ascending aorta and begins at the level of the second sternocostal joint. • It arches superiorly, posteriorly and to the left before moving inferiorly. • The aortic arch ends at the level of the T4 vertebra / at level of sternal angle. Branches; Brachiocephalic artery (Innominate artery) Left common carotid artery Left subclavian artery It begins when the ascending aorta emerges from the pericardial sac and courses upward, backward, and to the left as it passes through the superior mediastinum, ending on the left side at vertebral level TIV/V. Extending as high as the midlevel of the manubrium of the sternum, the arch is initially anterior and finally lateral to the trachea. -
Aneurysm of the Ascending Aorta Presenting with Pulmonary Stenosis
Thorax: first published as 10.1136/thx.21.3.236 on 1 May 1966. Downloaded from Thorax (1966), 21, 236. Aneurysm of the ascending aorta presenting with pulmonary stenosis M. H. YACOUB, M. V. BRAIMBRIDGE,1 AND R. G. GOLD From the Brornpton Hospital, London S.W.3 The symptoms and signs of aneurysms of the The chest radiograph (Fig. 1) showed old bilateral thoracic aorta are due mainly to compression of apical tuberculosis, and both lungs were emphyse- surrounding mediastinal structures and depend on matous. The emphysema was most marked in the left the size and location of the aneurysm. Compres- upper lobe with bullae present. A hemispherical mass, sion of the trachea, bronchi, oesophagus, recurrent 9 by 6 cm., lay to the left and in front of the ascend- ing aorta. Its border was slightly irregular. and laryngeal nerve, bone, and superior vena cava is showed flecks of linear calcification laterally and common, but pressure on the pulmonary artery has superiorly. The heart size was within normal limits. not been described in spite of its intimate relation At right heart catheterization difficulty was experi- to the ascending aorta. enced in passing the catheter into the pulmonary The object of this paper is to describe a case artery. The right ventricular systolic pressure was presenting in this way and to discuss the particular 44 mm. Hg and the pulmonary artery systolic pres- surgical problems involved in the excision of such sure was 18 mm. Hg. the systolic gradient being 24 an aneurysm. mm. Hg, with a single change in pressure fromarterial to ventricular configuration in the vicinity of the pulmonary valve. -
Blood Vessels and Circulation
19 Blood Vessels and Circulation Lecture Presentation by Lori Garrett © 2018 Pearson Education, Inc. Section 1: Functional Anatomy of Blood Vessels Learning Outcomes 19.1 Distinguish between the pulmonary and systemic circuits, and identify afferent and efferent blood vessels. 19.2 Distinguish among the types of blood vessels on the basis of their structure and function. 19.3 Describe the structures of capillaries and their functions in the exchange of dissolved materials between blood and interstitial fluid. 19.4 Describe the venous system, and indicate the distribution of blood within the cardiovascular system. © 2018 Pearson Education, Inc. Module 19.1: The heart pumps blood, in sequence, through the arteries, capillaries, and veins of the pulmonary and systemic circuits Blood vessels . Blood vessels conduct blood between the heart and peripheral tissues . Arteries (carry blood away from the heart) • Also called efferent vessels . Veins (carry blood to the heart) • Also called afferent vessels . Capillaries (exchange substances between blood and tissues) • Interconnect smallest arteries and smallest veins © 2018 Pearson Education, Inc. Module 19.1: Blood vessels and circuits Two circuits 1. Pulmonary circuit • To and from gas exchange surfaces in the lungs 2. Systemic circuit • To and from rest of body © 2018 Pearson Education, Inc. Module 19.1: Blood vessels and circuits Circulation pathway through circuits 1. Right atrium (entry chamber) • Collects blood from systemic circuit • To right ventricle to pulmonary circuit 2. Pulmonary circuit • Pulmonary arteries to pulmonary capillaries to pulmonary veins © 2018 Pearson Education, Inc. Module 19.1: Blood vessels and circuits Circulation pathway through circuits (continued) 3. Left atrium • Receives blood from pulmonary circuit • To left ventricle to systemic circuit 4.