An Unusual Origin and Course of the Thyroidea Ima Artery, with Absence of Inferior Thyroid Artery Bilaterally
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Ipsilateral Subclavian Steal in Association with Aberrant Origin of the Left Vertebral Artery from the Aortic Arch
411 Ipsilateral Subclavian Steal in Association with Aberrant Origin of the Left Vertebral Artery from the Aortic Arch John Holder1 Five cases are reported of left subclavian steal syndrome associated with anomalous Eugene F. Binet2 origin of the left vertebral artery from the aortic arch. In all five instances blood flow at Bernard Thompson3 the origin of the left vertebral artery was in an antegrade direction contrary to that usually reported in this condition. The distal subclavian artery was supplied via an extensive collateral network of vessels connecting the vertebral artery to the thyro cervical trunk. If a significant stenosis or occlusion is present within the left subc lavi an artery proximal to the origin of the left vertebral artery, the direction of the bl ood fl ow within the vertebral artery will reverse toward the parent vessel (retrograde flow). This phenomenon occurs when a negative pressure gradient of 20-40 torr exists between the vertebral-basilar artery junction and th e vertebral-subc lavian artery junction [1-3]. We describe five cases of subclavian steal confirmed by angiography where a significant stenosis or occlusion of the left subclavian artery was demonstrated in association with anomalous origin of th e left vertebral artery directly from the aortic arch. In all five cases blood flow at the origin of the left vertebral artery was in an antegrade direction contrary to that more commonly reported in the subclavian steal syndrome. Materials and Methods The five patients were all 44- 58-year-old men. Three sought medical attention for symptoms specificall y related to th e left arm . -
Cervical Viscera and Root of Neck
Cervical viscera & Root of neck 頸部臟器 與 頸根部 解剖學科 馮琮涵 副教授 分機 3250 E-mail: [email protected] Outline: • Position and structure of cervical viscera • Blood supply and nerve innervation of cervical viscera • Contents in root of neck Viscera of the Neck Endocrine layer – thyroid and parathyroid glands Respiratory layer – larynx and trachea Alimentary layer – pharynx and esophagus Thyroid gland Position: deep to sterno-thyroid and sterno-hyoid ms. (the level of C5 to T1) coverd by pretracheal deep cervical fascia (loose sheath) and capsule (dense connective tissue) anterolateral to the trachea arteries: superior thyroid artery – ant. & post. branches inferior thyroid artery (br. of thyrocervical trunk) thyroid ima artery (10%) Veins: superior thyroid vein IJVs (internal jugular veins) middle thyroid vein IJVs inferior thyroid vein brachiocephalic vein Thyroid gland Lymphatic drainage: prelaryngeal, pretracheal and paratracheal • lymph nodes inferior deep cervical lymph nodes Nerves: superior, middle & inferior cervical sympathetic ganglia periarterial plexuses • # thyroglossal duct cysts, pyramidal lobe (50%) # Parathyroid glands Position: external to thyroid capsule, but inside its sheath superior parathyroid glands – 1 cm sup. to the point of inf. thyroid artery into thyroid inferior parathyroid glands – 1 cm inf. to inf. thyroid artery entry point (various position) Vessels: branches of inf. thyroid artery or sup. thyroid artery parathyroid veins venous plexuses of ant. surface of thyroid Nerves: thyroid branches of the cervical sympathetic ganglia Trachea Tracheal rings (C-shape cartilage) + trachealis (smooth m.) Position: C6 (inf. end of the larynx) – T4/T5 (sternal angle) # trache`ostomy – 1st and 2nd or 2nd through 4th tracheal rings # care: inf. thyroid veins, thyroid ima artery, brachiocephalic vein, thymus and trachea Esophagus Position: from the inf. -
Neurovascular Anatomy (1): Anterior Circulation Anatomy
Neurovascular Anatomy (1): Anterior Circulation Anatomy Natthapon Rattanathamsakul, MD. December 14th, 2017 Contents: Neurovascular Anatomy Arterial supply of the brain . Anterior circulation . Posterior circulation Arterial supply of the spinal cord Venous system of the brain Neurovascular Anatomy (1): Anatomy of the Anterior Circulation Carotid artery system Ophthalmic artery Arterial circle of Willis Arterial territories of the cerebrum Cerebral Vasculature • Anterior circulation: Internal carotid artery • Posterior circulation: Vertebrobasilar system • All originates at the arch of aorta Flemming KD, Jones LK. Mayo Clinic neurology board review: Basic science and psychiatry for initial certification. 2015 Common Carotid Artery • Carotid bifurcation at the level of C3-4 vertebra or superior border of thyroid cartilage External carotid artery Supply the head & neck, except for the brain the eyes Internal carotid artery • Supply the brain the eyes • Enter the skull via the carotid canal Netter FH. Atlas of human anatomy, 6th ed. 2014 Angiographic Correlation Uflacker R. Atlas of vascular anatomy: an angiographic approach, 2007 External Carotid Artery External carotid artery • Superior thyroid artery • Lingual artery • Facial artery • Ascending pharyngeal artery • Posterior auricular artery • Occipital artery • Maxillary artery • Superficial temporal artery • Middle meningeal artery – epidural hemorrhage Netter FH. Atlas of human anatomy, 6th ed. 2014 Middle meningeal artery Epidural hematoma http://www.jrlawfirm.com/library/subdural-epidural-hematoma -
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ONLINE FIRST This is a provisional PDF only. Copyedited and fully formatted version will be made available soon. ISSN: 0015-5659 e-ISSN: 1644-3284 Two cases of combined anatomical variations: maxillofacial trunk, vertebral, posterior communicating and anterior cerebral atresia, linguofacial and labiomental trunks Authors: M. C. Rusu, A. M. Jianu, M. D. Monea, A. C. Ilie DOI: 10.5603/FM.a2021.0007 Article type: Case report Submitted: 2020-11-28 Accepted: 2021-01-08 Published online: 2021-01-29 This article has been peer reviewed and published immediately upon acceptance. It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Folia Morphologica" are listed in PubMed. Powered by TCPDF (www.tcpdf.org) Two cases of combined anatomical variations: maxillofacial trunk, vertebral, posterior communicating and anterior cerebral atresia, linguofacial and labiomental trunks M.C. Rusu et al., The maxillofacial trunk M.C. Rusu1, A.M. Jianu2, M.D. Monea2, A.C. Ilie3 1Division of Anatomy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2Department of Anatomy, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania 3Department of Functional Sciences, Discipline of Public Health, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania Address for correspondence: M.C. Rusu, MD, PhD (Med.), PhD (Biol.), Dr. Hab., Prof., Division of Anatomy, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., RO-76241, Bucharest, Romania, , tel: +40722363705 e-mail: [email protected] ABSTRACT Background: Commonly, arterial anatomic variants are reported as single entities. -
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. -
Downhill Varices Resulting from Giant Intrathoracic Goiter
E40 UCTN – Unusual cases and technical notes Downhill varices resulting from giant intrathoracic goiter Fig. 2 Sagittal com- puted tomography of the chest. The goiter was immense, reaching the aortic arch, sur- rounding the trachea and partially compres- sing the upper esopha- gus. The esophagus was additionally com- pressed by anterior spinal spondylophytes. Fig. 1 Multiple submucosal veins in the upper esophagus, consistent with downhill varices. An 82-year-old man was admitted to the hospital because of substernal chest pain, dyspnea, and occasional dysphagia to sol- ids. His past medical history was remark- geal varices are called “downhill varices”, References able for diabetes mellitus type II, hyper- as they are located in the upper esophagus 1 Kotfila R, Trudeau W. Extraesophageal vari- – lipidemia, and Parkinson’s disease. On and project downwards. Downhill varices ces. Dig Dis 1998; 16: 232 241 2 Basaranoglu M, Ozdemir S, Celik AF et al. A occur as a result of shunting in cases of up- physical examination he appeared frail case of fibrosing mediastinitis with obstruc- but with no apparent distress. Examina- per systemic venous obstruction from tion of superior vena cava and downhill tion of the neck showed no masses, stri- space-occupying lesions in the medias- esophageal varices: a rare cause of upper dor or jugular venous distension. Heart tinum [2,3]. Downhill varices as a result of gastrointestinal hemorrhage. J Clin Gastro- – examination disclosed a regular rate and mediastinal processes are reported to enterol 1999; 28: 268 270 3 Calderwood AH, Mishkin DS. Downhill rhythm; however a 2/6 systolic ejection occur in up to 50% of patients [3,4]. -
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. -
Embolization for Hemoptysis—Angiographic Anatomy of Bronchial and Systemic Arteries
THIEME 184 Pictorial Essay Embolization for Hemoptysis—Angiographic Anatomy of Bronchial and Systemic Arteries Vikash Srinivasaiah Setty Chennur1 Kumar Kempegowda Shashi1 Stephen Edward Ryan1 1 1 Adnan Hadziomerovic Ashish Gupta 1Division of Angio-Interventional Radiology, Department of Medical Address for correspondence Ashish Gupta, MD, Division of Imaging, University of Ottawa, The Ottawa Hospital, Ottawa, Angio-Interventional Radiology, Department of Medical Imaging, Ontario, Canada University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada (e-mail: [email protected]). J Clin Interv Radiol ISVIR 2018;2:184–190 Abstract Massive hemoptysis is a potentially fatal respiratory emergency. The majority of these patients are referred to interventional radiology for bronchial artery embolization (BAE). Immediate clinical success in stopping hemoptysis ranges from 70 to 99%. However, recurrent hemoptysis after BAE is seen in 10 to 55% patients. One of the main reasons for recurrence is incomplete embolization due to unidentified aberrant Keywords bronchial and/or non-bronchial systemic arterial supply. This pictorial essay aims to ► bronchial describe the normal and variant bronchial arterial anatomy and non-bronchial systemic ► embolization arterial feeders to the lungs on conventional angiography; the knowledge of which is ► hemoptysis critical for interventional radiologists involved in the care of patients with hemoptysis. Introduction Angiographic Anatomy of Bronchial Arteries Massive hemoptysis is a respiratory -
The Vertebral Artery in the Vascular Lab: What Does It Mean?
The Vertebral Artery in the Vascular Lab: What Does It Mean? Caron Rockman MD Frances and Joseph Ritroto Professor of Surgery Program Director, Vascular Surgery New York University Langone Medical Center Disclosures •None Division of Vascular and Endovascular Surgery Subclavian Steal Occlusion of proximal Subclavian Art Vertebral artery supplies retrograde flow Posterior brain receives decreased flow 55 years + Men > Women more than 2:1 LSA affected 3x more than RSA Division of Vascular and Endovascular Surgery Subclavian Steal Causes: - Arteriosclerosis of subclavian artery (>95% cases) - Embolism - Takayasu’s Arteritis -Dissecting Aneurysm Risk Factors: (similar to CAD) -Smoking -Hypertension -Hyperlipidemia -Hypertension Division of Vascular and Endovascular Surgery Symptoms of Subclavian Steal Vertebrobasilar Insufficiency (posterior circulation symptoms) Light headedness or dizziness Ataxia or Vertigo Visual Disturbance Headache Syncope Confusion Division of Vascular and Endovascular Surgery Symptoms of Subclavian Steal Subclavian Insufficiency Arm weakness, coldness Numbness or “tingling” Arm Claudication with exercise Symptoms can be exacerbated with: Vigorous exercise Sudden turning of head to affected side Division of Vascular and Endovascular Surgery Signs of Subclavian Steal Diminished pulses (radial/ulnar) Discrepant blood pressures in upper extremities (>20mmHg) (Pitfall with bilateral disease) Subclavian Bruit 7 Division of Vascular and Endovascular Surgery Subclavian steal on Duplex Exam Incomplete steal •Striking deceleration of velocity in mid or late systole •High grade stenosis of subclavian rather than occlusion Complete Steal •Complete reversal of flow within the vertebral artery Division of Vascular and Endovascular Surgery Vertebral Retrograde Flow • Reversal of flow in the vertebral artery is a common finding identified on cerebrovascular duplex ultrasound. • The clinical significance and natural history of patients presenting with this finding, however, is poorly understood. -
Selective Venous Sampling for Primary Hyperparathyroidism: How to Perform an Examination and Interpret the Results with Reference to Thyroid Vein Anatomy
Jpn J Radiol DOI 10.1007/s11604-017-0658-3 INVITED REVIEW Selective venous sampling for primary hyperparathyroidism: how to perform an examination and interpret the results with reference to thyroid vein anatomy Takayuki Yamada1 · Masaya Ikuno1 · Yasumoto Shinjo1 · Atsushi Hiroishi1 · Shoichiro Matsushita1 · Tsuyoshi Morimoto1 · Reiko Kumano1 · Kunihiro Yagihashi1 · Takuyuki Katabami2 Received: 11 April 2017 / Accepted: 28 May 2017 © Japan Radiological Society 2017 Abstract Primary hyperparathyroidism (pHPT) causes and brachiocephalic veins for catheterization of the thyroid hypercalcemia. The treatment for pHPT is surgical dis- veins and venous anastomoses. section of the hyperfunctioning parathyroid gland. Lower rates of hypocalcemia and recurrent laryngeal nerve injury Keywords Primary hyperparathyroidism · Localization · imply that minimally invasive parathyroidectomy (MIP) is Thyroid vein · Venous sampling safer than bilateral neck resection. Current trends in MIP use can be inferred only by reference to preoperative locali- zation studies. Noninvasive imaging studies (typically pre- Introduction operative localization studies) show good detection rates of hyperfunctioning glands; however, there have also been Primary hyperparathyroidism (pHPT) is a common endocrine cases of nonlocalization or discordant results. Selective disease. Most patients have one adenoma, but double adeno- venous sampling (SVS) is an invasive localization method mas have been reported in up to 15% of cases [1]. Approxi- for detecting elevated intact parathyroid -
Intercostal Arteries a Single Posterior & Two Anterior Intercostal Arteries
Intercostal Arteries •Each intercostal space contains: . A single posterior & .Two anterior intercostal arteries •Each artery gives off branches to the muscles, skin, parietal pleura Posterior Intercostal Arteries In the upper two spaces, arise from the superior intercostal artery (a branch of costocervical trunk of the subclavian artery) In the lower nine spaces, arise from the branches of thoracic aorta The course and branching of the intercostal arteries follow the intercostal Posterior intercostal artery Course of intercostal vessels in the posterior thoracic wall Anterior Intercostal Arteries In the upper six spaces, arise from the internal thoracic artery In the lower three spaces arise from the musculophrenic artery (one of the terminal branch of internal thoracic) Form anastomosis with the posterior intercostal arteries Intercostal Veins Accompany intercostal arteries and nerves Each space has posterior & anterior intercostal veins Eleven posterior intercostal and one subcostal vein Lie deepest in the costal grooves Contain valves which direct the blood posteriorly Posterior Intercostal Veins On right side: • The first space drains into the right brachiocephalic vein • Rest of the intercostal spaces drain into the azygos vein On left side: • The upper three spaces drain into the left brachiocephalic vein. • Rest of the intercostal spaces drain into the hemiazygos and accessory hemiazygos veins, which drain into the azygos vein Anterior Intercostal Veins • The lower five spaces drain into the musculophrenic vein (one of the tributary of internal thoracic vein) • The upper six spaces drain into the internal thoracic vein • The internal thoracic vein drains into the subclavian vein. Lymphatics • Anteriorly drain into anterior intercostal nodes that lie along the internal thoracic artery • Posterioly drain into posterior intercostal nodes that lie in the posterior mediastinum .