DOCSLIB.ORG

Anatomical Study of the Coexistence of the Postaortic Left Brachiocephalic Vein with the Postaortic Left Renal Vein with a Review of the Literature

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anatomical Study of the Coexistence of the Postaortic Left Brachiocephalic Vein with the Postaortic Left Renal Vein with a Review of the Literature Okajimas Folia Anat.Coexistence Jpn., 91(3): of 73–81, postaortic November, veins 201473 Anatomical study of the coexistence of the postaortic left brachiocephalic vein with the postaortic left renal vein with a review of the literature By Akira IIMURA1, Takeshi OGUCHI1, Masato MATSUO1 Shogo HAYASHI2, Hiroshi MORIYAMA2 and Masahiro ITOH2 1Dental Anatomy Division, Department of Oral Science, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan 2Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160, Japan –Received for Publication, December 11, 2014– Key Words: venous anomaly, postaortic vein, left brachiocephalic vein, left renal vein Summary: In a student course of gross anatomy dissection at Kanagawa Dental University in 2009, we found an extremely rare case of the coexistence of the postaortic left brachiocephalic vein with the postaortic left renal vein of a 73-year-old Japanese male cadaver. The left brachiocephalic vein passes behind the ascending aorta and connects with the right brachio- cephalic vein, and the left renal vein passes behind the abdominal aorta. These two anomalous cases mentioned above have been reported respectively. There have been few reports discussing coexistence of the postaortic left brachiocephalic vein with the postaortic left renal vein. We discuss the anatomical and embryological aspect of this anomaly with reference in the literature. Introduction phalic vein (PALBV) with the postaortic left renal vein (PALRV). These two anomalous cases mentioned above Normally, the left brachiocephalic vein passes in have been reported respectively. There have been few or front of the left common carotid artery and the brachio- no reports discussing coexistence of the PALBV with the cephalic artery and connects with the right brachioce- PALRV. phalic vein. The superior vena cava is formed by the Based on the observations of these anomalous cases, right and left brachiocephalic veins. The azygos vein we discuss ourvariation case from the anatomical and joins the superior vena cava just before it enters the embryological aspects in the present study. right atrium in the upper right anterior part of the heart. There have been reports discussing a variation, which shows that the left brachiocephalic vein passes behind the Subject and Methods ascending aorta and connects with the right brachioce- phalic vein (Kerschner, 1888; Daser, 1902; Ghon, 1908; This article describes dissection of a 73-year-old Japa- Nützel, 1914; Martin, 1931; Walter, 1931; Adachi, 1933; nese male cadaver during routine educational dissection Freidman, 1945; Jakubczik and Zeigler, 1963; Yoshida at the laboratory of anatomy of Knagawa Dental Univer- and Fukuyama, 1975; Kitamura, 1981; Yoshida, 1984; sity. Tsujimura, 2007; Ohsawa, 2011). The cause of death was cerebral hemorrhage. Gross On the other hand, with regard to the renal veins, there dissections was performed according to the usual proce- has been a report discussing a anomaly, which shows that dures, and the PALBV and PALRV were morphologically the left renal vein passes behind the abdominal aorta. observed. Slide calipers were used for the measurements. During routine educational dissection, we encountered a case of coexistence of the postaortic left brachioce- Corresponding author: Akira Iimura, Dental Anatomy Division, Department of Oral Science, Kanagawa Dental University, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan. E-mail: [email protected] 74 A. Iimura et al. Part I. The postaortic left brachiocepalic vein (PALBV) Results Right and left brachiocephalic veins The left internal jugular, left external jugular and left subclavian veins joined to form the left brachiocephalic vein (width 26.2 mm; diameter, 16.7 mm). The left brachiocephalic vein went downward into the thorax, and passed in front of the left subclavian artery. And the vein ran across the thorax from left to right, below the proximal portion of the aortic arch and behind the ascending aorta and joined the right brachiocephalic vein, which forms the superior vena cava. At this point the left brachiocephalic vein passed above the pulmonary artery through the lateral side of the ligamentum arteriosum Fig. 1. Diagram of the heart and vessels of this case. The left brachio- (Fig. 1 and 2). cephalic vein passed the ventral side on the left side of the aortic There was a bulge of 25.3 mm in diameter 23.8 mm arch. It then ran laterally on the left side of the ligamentum arte- to the left of the junction of the right and left brachio- riosum and on the dorsal side of the ascending aorta and joined cephalic veins. No veins equivalent to the normal left the right brachiocephalic vein to form the superior vena cava. At this site the left brachiocephalic vein passed lateral to the brachiocephalic vein, which passed in front of the ligamentum arteriosum. The left vertebral artery arose from the brachiocephalic artery and left common carotid artery, upper wall of the aorta as a point of divergence between the left were observed. The superior vena cava (diameter, 23.3 common carotid artery and left subclavian artery. mm) was formed by the union of the left brachiocephalic vein and right brachiocephalic vein (diameter, 16.2 mm; length, 53.9 mm). After receiving the azygos vein (diam- eter, 11.8 mm), the right brachiocephalic vein connected with the left brachiocepalic vein. The length of the supe- rior vena cava was shorter than the normal one, but the opening to the right atrium was normal (Fig. 3). The azygos vein was incompletely formed, and no hemiazygos veins were observed. This vein passed in front of the lumbar vertebral body from the lower side to the upper side and joined the right brachiocephalic vein. On the left side, several intercostal veins were connected to each other and drained into the azygos vein. The vein, which joined the azygos vein at the level of the 4th thoracic vertebra, received the 1st to 3rd intercostal veins. Accordingly, it is considered that this vein corresponds to the accessory hemiazygos vein.The vein, which joined the azygos vein at the levels of the 6th and 8th thoracic vertebrae, received nearby two intercostal veins. Other left intercostal veins independently connected with the azygos vein respectively. The azygos vein connected with the right brachiocephalic vein, not the superior vena cava. The (1st-4th) intercostal veins of the right upper chest had connected with each other, and entered the azygos vein (Fig. 4). Fig. 2. Anterior view of the heart. The right and left brachiocephalic Left vertebral artery veins descended so as to be on either side of the aortic arch. The The left vertebral artery ( diameter, 4.0 mm ) arose left brachiocephalic vein passed in front of the left side of the from the aortic arch between the left common carotid aortic arch and the left side of the ligamentum arteriosum. This vein went further behind the ascending aorta. artery and left brachiocephalic artery. The left vertebral artery ascended along the left common carotid artery, and entered the transverse foramen of the 5th cervical Coexistence of postaortic veins 75 Fig. 3. Posterior view of the heart. The left brachiocephalic vein Fig. 4. Azygos vein. The hemiazygos vein formation was insufficient. passed between the aorta and pulmonary artery, and joined the The left intercostal vein directly joined with the azygos vein, right brachiocephalic vein to form the superior vena cava. An otherwise two left intercostal veins united with each other to join azygos vein joined the right brachiocephalic vein just above the the azygos vein. In the upper intercostal part, formation of an junction between the right and left brachiocephalic veins. accessory hemiazygos vein was confirmed. vertebra. Normally, the vertebral artery enters the trans- verse foramen of the 6th cervical vertebra (Fig. 5). Discussion The incidence Such a anomaly is referred to by the PALBV. There have been some morphological reports on the PALBV in dissecting cadavers (Kerschner, 1888; Daser, 1902; Ghon, 1908; Nützel, 1914; Martin, 1931; Walter, 1931; Adachi, 1933; Freidman, 1945; Jakubczik and Zeigler, 1963; Yoshida and Fukuyama, 1975; Kitamura, 1981; Yoshida, 1984; Tsujimura, 2007; Ohsawa, 2009; R.Ohsawa, 2011). The reports on the anomaly except those based on dissec- tion, were based on the observations during the clinical diagnosis and operation. When the clinical diagnosis cases and operation cases were combined, the number Fig. 5. The left vertebral artery. The left vertebral artery arose from of reports would exceed 100. In the 1970s, the majority the upper wall of the aortic arch between the left common carot- id artery and the left subclavian artery, and had entered the 5th of the reports on the anomaly have dealt with the cases transverse foramen. observed by operation. After the 1980s however, the anomaly which was observed with diagnostic imaging apparatuses including computed tomography (CT) and magnetic resonance with cardiovascular disease into the following groups: imaging (MRI), has increasingly been reported. (Curtil, (1) Coexistence with cardiac disease; 1999; Bartoli, 1990; Kaneko, 1995; Nakanura, 1995; (2) Coexistence with cardiac disease and an anomaly of Gülsün, 2003; Yilmaz, 2007; Nagashima, 2010). Several the aortic arch; and reports have shown in the patients who have had congen- (3) Coexistence with an anomaly of the aortic arch. ital heart disease such as tetralogy of Fallot that the inci- The present anomalies; it is highly associated with dence of the anomaly is high. (Kitamura, 1981; Curtil, cardiac anomalies and aortic arch anomalies including 1999; Nagashima, 2010). the right aortic arch and cervical aortic arch (Nagashima, Nagashima classified the anomaly, which coexisted 2010). Minami(1993) indicated correlation of the high 76 A. Iimura et al. aortic arch with the postaortic left brachiocephalic cephalic vein passing the dorsal side of a branch of the vein. The incidence of the postaortic left brachioce- aortic arch; type c, the PALBV passing ventral side of the phalic vein was only 0.02% in patients without congen- ligamentum arteriosum (Adachi’s type I); and type d, the ital heart disease (Nagashima, 2010).
Load more

Recommended publications
  • Endocrine Block اللهم ال سهل اال ما جعلته سهل و أنت جتعل احلزن اذا شئت سهل
    OSPE ENDOCRINE BLOCK اللهم ﻻ سهل اﻻ ما جعلته سهل و أنت جتعل احلزن اذا شئت سهل Important Points 1. Don’t forget to mention right and left. 2. Read the questions carefully. 3. Make sure your write the FULL name of the structures with the correct spelling. Example: IVC ✕ Inferior Vena Cava ✓ Aorta ✕ Abdominal aorta ✓ 4. There is NO guarantee whether or not the exam will go out of this file. ممكن يأشرون على أجزاء مو معلمه فراح نحط بيانات إضافية حاولوا تمرون عليها كلها Good luck! Pituitary gland Identify: 1. Anterior and posterior clinoidal process of sella turcica. 2. Hypophyseal fossa (sella turcica) Theory • The pituitary gland is located in middle cranial fossa and protected in sella turcica (hypophyseal fossa) of body of sphenoid. Relations Of Pituitary Gland hypothalamus Identify: 1. Mamillary body (posteriorly) 2. Optic chiasma (anteriorly) 3. Sphenoidal air sinuses (inferior) 4. Body of sphenoid 5. Pituitary gland Theory • If pituitary gland became enlarged (e.g adenoma) it will cause pressure on optic chiasma and lead to bilateral temporal eye field blindness (bilateral hemianopia) Relations Of Pituitary Gland Important! Identify: 1. Pituitary gland. 2. Diaphragma sellae (superior) 3. Sphenoidal air sinuses (inferior) 4. Cavernous sinuses (lateral) 5. Abducent nerve 6. Oculomotor nerve 7. Trochlear nerve 8. Ophthalmic nerve 9. Trigeminal (Maxillary) nerve Structures of lateral wall 10. Internal carotid artery Note: Ophthalmic and maxillary are both branches of the trigeminal nerve Divisions of Pituitary Gland Identify: 1. Anterior lobe (Adenohypophysis) 2. Optic chiasma 3. Infundibulum 4. Posterior lobe (Neurohypophysis) Theory Anterior Lobe Posterior Lobe • Adenohypophysis • Neurohypophysis • Secretes hormones • Stores hormones • Vascular connection to • Neural connection to hypothalamus by hypothalamus by Subdivisions hypophyseal portal hypothalamo-hypophyseal system (from superior tract from supraoptic and hypophyseal artery) paraventricular nuclei.
    [Show full text]
  • Ultrasonography of the Scrotum in Adults
    University of Massachusetts Medical School eScholarship@UMMS Radiology Publications and Presentations Radiology 2016-07-01 Ultrasonography of the scrotum in adults Anna L. Kuhn University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/radiology_pubs Part of the Male Urogenital Diseases Commons, Radiology Commons, Reproductive and Urinary Physiology Commons, Urogenital System Commons, and the Urology Commons Repository Citation Kuhn AL, Scortegagna E, Nowitzki KM, Kim YH. (2016). Ultrasonography of the scrotum in adults. Radiology Publications and Presentations. https://doi.org/10.14366/usg.15075. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/173 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Radiology Publications and Presentations by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Ultrasonography of the scrotum in adults Anna L. Kühn, Eduardo Scortegagna, Kristina M. Nowitzki, Young H. Kim Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA REVIEW ARTICLE Ultrasonography is the ideal noninvasive imaging modality for evaluation of scrotal http://dx.doi.org/10.14366/usg.15075 abnormalities. It is capable of differentiating the most important etiologies of acute scrotal pain pISSN: 2288-5919 • eISSN: 2288-5943 and swelling, including epididymitis and testicular torsion, and is the imaging modality of choice Ultrasonography 2016;35:180-197 in acute scrotal trauma. In patients presenting with palpable abnormality or scrotal swelling, ultrasonography can detect, locate, and characterize both intratesticular and extratesticular masses and other abnormalities.
    [Show full text]
  • 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.
    [Show full text]
  • Bilateral Variations of the Testicular Vessels: Embryological Background and Clinical Implications
    Case Report Bilateral Variations of the Testicular Vessels: Embryological Background and Clinical Implications Yogesh Diwan, Rikki Singal1, Deepa Diwan, Subhash Goyal1, Samita Singal2, Mausam Kapil1 Department of Anatomy, Indira Gandhi Medical College, Shimla, 1Surgery and 2Radiology, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, India ABSTRACT Variations of the testicular vessels were observed during routine dissection of the posterior abdominal wall in a male North Indian cadaver. On the right side, the testicular vein drained into the right renal vein and the right testicular artery passed posterior to the inferior vena cava. The left testicular vein was composed of the lateral and medial testicular veins which drained into the left renal vein independently. Left renal vein had received an additional tributary, first lumbar vein, and the left testicular artery had hooked this additional tributary to run along its normal course. KEY WORDS: Inferior vena cava, renal vein, testicular artery, testicular vein INTRODUCTION vessels are relatively constant, occasional developmental and anatomical variations have been reported. However, The testicular arteries arise anteriorly from the abdominal variations of the testicular veins associated with variations aorta, a little inferior to the renal arteries. The vertebral level of the testicular arteries are seldom seen.[3] of their origin varies from the 1st to the 3rd lumbar vertebrae. Each passes inferolaterally under the parietal peritoneum In the present report, we investigate the drainage, course, on the psoas major. The right testicular artery commonly tributaries of the testicular veins, the origin and course of passes ventrally to the inferior vena cava. Each artery crosses the testicular arteries, and discuss their embryogenesis and anterior to the genitofemoral nerve, ureter and the lower clinical significance.
    [Show full text]
  • Double Inferior Vena Cava Associated with Double Suprarenal and Testicular Venous Anomalies: a Rare Case Report
    THIEME Brief Communication 221 Double Inferior Vena Cava Associated with Double Suprarenal and Testicular Venous Anomalies: A Rare Case Report Kimaporn Khamanarong1 Jarupon Mahiphot1 Sitthichai Iamsaard1,2 1 Department of Anatomy, Faculty of Medicine of Khon Kaen Address for correspondence Sitthichai Iamsaard, PhD, Department University, Khon Kaen, Thailand of Anatomy, Faculty of Medicine of Khon Kaen University, Khon Kaen, 2 Center for Research and Development of Herbal Health Products, Thailand, 40002 (e-mail: [email protected]). Faculty of Pharmaceutical Sciences of Khon Kaen University, Khon Kaen, Thailand J Morphol Sci 2018;35:221–224. Abstract Introduction The variant courses of blood vessels are very important in considera- tions for retroperitoneal surgeries or interventional radiology. The present study attempted to describe a very rare case of double inferior vena cava (IVC) associated with double left suprarenal veins (LSRVs) and double right testicular veins (RTVs) in a Thai male embalmed cadaver. Material and Methods A 70-year-old Thai male cadaver was systemically dissected and observed for the vascular distributions during gross anatomy teaching for medical students at the anatomy department of the faculty of medicine of the Khon Kaen University. Keywords Results We found that the double IVCs were connected with the transverse interiliac ► double inferior vena vein. While the upper LSRV is a tributary of the IVC, the lower LSRV is a tributary of the cava left renal vein. The RTV bifurcates at about the height of the iliac cristae to form the ► double suprarenal medial and lateral RTVs, which drain into the right IVC at different heights. veins Conclusion All these duplications and associated anomalies are assumed to occur ► double right during the embryological development.
    [Show full text]
  • Cat Dissection
    Cat Dissection Muscular Labs Tibialis anterior External oblique Pectroalis minor Sartorius Gastrocnemius Pectoralis major Levator scapula External oblique Trapezius Gastrocnemius Semitendinosis Trapezius Latissimus dorsi Sartorius Gluteal muscles Biceps femoris Deltoid Trapezius Deltoid Lumbodorsal fascia Sternohyoid Sternomastoid Pectoralis minor Pectoralis major Rectus abdominis Transverse abdominis External oblique External oblique (reflected) Internal oblique Lumbodorsal Deltoid fascia Latissimus dorsi Trapezius Trapezius Trapezius Deltoid Levator scapula Deltoid Trapezius Trapezius Trapezius Latissimus dorsi Flexor carpi radialis Brachioradialis Extensor carpi radialis Flexor carpi ulnaris Biceps brachii Triceps brachii Biceps brachii Flexor carpi radialis Flexor carpi ulnaris Extensor carpi ulnaris Triceps brachii Extensor carpi radialis longus Triceps brachii Deltoid Deltoid Deltoid Trapezius Sartorius Adductor longus Adductor femoris Semimembranosus Vastus Tensor fasciae latae medialis Rectus femoris Vastus lateralis Tibialis anterior Gastrocnemius Flexor digitorum longus Biceps femoris Tensor fasciae latae Semimembranosus Semitendinosus Gluteus medius Gluteus maximus Extensor digitorum longus Gastrocnemius Soleus Fibularis muscles Brachioradiallis Triceps (lateral and long heads) Brachioradialis Biceps brachii Triceps (medial head) Trapezius Deltoid Deltoid Levator scapula Trapezius Deltoid Trapezius Latissimus dorsi External oblique (right side cut and reflected) Rectus abdominis Transversus abdominis Internal oblique Pectoralis
    [Show full text]
  • Arched Left Gonadal Artery Over the Left Renal Vein Associated with Double Left Renal Artery Ranade a V, Rai R, Prahbu L V, Mangala K, Nayak S R
    Case Report Singapore Med J 2007; 48(12) : e332 Arched left gonadal artery over the left renal vein associated with double left renal artery Ranade A V, Rai R, Prahbu L V, Mangala K, Nayak S R ABSTRACT Variations in the anatomical relationship of the gonadal arteries to the renal vessels are frequently reported. We present, on a male cadaver, an unusual origin and course of a left testicular artery arching over the left renal vein along with double renal arteries. The development of this anomaly is discussed in detail. Compression of the left renal vein between the abdominal aorta and the superior mesenteric artery usually induces left renal vein hypertension, resulting in varicocele. We propose that the arching of left testicular artery over the left renal vein could be an additional possible cause of the left renal vein compression. Therefore, knowledge of the possible existence of arching gonadal vessels in relation to the renal vein could be of paramount importance to vascular surgeons and urologists during surgery in Fig. 1 Photograph shows the left testicular artery along with the retroperitoneal region. double left renal arteries after reflecting the inferior vena cava Department of downwards. Anatomy, 1. Left testicular artery; 2. Left kidney; 3. Left renal vein; Kasturba Medical 4. Inferior vena cava; 5. Abdominal aorta; 8. Superior left College, Keywords: anomalous gonadal vessels, Mangalore 575004, arched left gonadal artery, gonadal artery renal artery; 9. Inferior left renal artery; and 10. Double left Karnataka, renal vein.
    [Show full text]
  • Biology 2710 Unit #3 Lab Objectives - Online Histology - Blood
    Biology 2710 Unit #3 Lab Objectives - Online Histology - blood Objectives Source Erythrocyte (red blood cell), Leukocyte (white blood cell), Platelet Anatomy & Physiology Revealed (Connect) Tissues/Blood NOTE: know general functions of above formed elements Smartbook (Connect). Ch. 18 Anatomy of Heart Objectives Source Aorta, pulmonary trunk, superior vena cava, ligamentum arteriosum, Practice Atlas (Connect) left atrium, left auricle, left ventricle, right atrium, right auricle, right ventricle, Cardiovascular System/Heart/ right atrium, left atrium, right ventricle, left ventricle, bicuspid (mitral) valve, -great vessels of the heart, ANT. & POST. chordae tendoneae, fossa ovalis, interatrial septum, interventricular septum, -external heart chambers, ANT. & POST. papillary muscle, pulmonary semilunar valve, tricuspid valve, -internal heart chambers, all views anterior interventricular artery, right coronary artery, coronary sinus, marginal -coronary circulation, anterior/inferior artery, circumflex artery, left coronary artery, posterior interventricular artery, cardiac vein (any) Membranes – Heart and Lungs Objectives Source Parietal Pericardium, Parietal Pleura, Pericardial Cavity, Pleural Cavity, Anatomy & Physiology Revealed (Connect) Visceral Pericardium, Visceral Pleura Body Orientation/Body Cavities/ -Anterior and Lateral -Pleura and Pericardium Arteries Objectives Source Arch of aorta, thoracic (descending) aorta, brachiocephalic trunk, left common Practice Atlas (Connect) carotid artery, right common carotid artery, left subclavian
    [Show full text]
  • Pelvic Venous Disorders
    PELVIC VENOUS DISORDERS Anatomy and Pathophysiology Two Abdomino-Pelvic Compression Syndromes DIAGNOSIS of ABDOMINOO-PELVICP z Nutcracker Syndrome 9 Compression of the left renal vein COMPRESSIONCO SS O SYNDROMES S O with venous congestion of the left (with Emphasis on Duplex Ultrasound) kidney and left ovarian vein reflux R. Eugene Zierler, M.D. z May-Thurner Syndrome 9 Compression of the left common iliac vein by the right common The DD.. EE.. StrandnessStrandness,, JrJr.. Vascular Laboratory iliac artery with left lower University of Washington Medical Center extremity venous stasis and left DivisionDivision of Vascular Surgery internal iliac vein reflux University of Washington, School of Medicine ABDOMINO-PELVIC COMPRESSION Nutcracker Syndrome Left Renal Vein Entrapment z Grant 1937: Anatomical observation “…the left renal vein, as it lies between the aorta and superior mesenteric artery, resembles a nut between the jaws of a nutcracker.” X z El-Sadr 1950: Described first patient with the clinical syndrome X z De Shepper 1972: Named the disorder “Nutcracker Syndrome” Copy Here z Nutcracker Phenomenon z Nutcracker Syndrome 9 Anatomic finding only 9 Hematuria, proteinuria 9 Compression of left renal 9 Flank pain vein - medial narrowing 9 Pelvic pain/congestion with lateral (hilar) dilation 9 Varicocele ABDOMINO-PELVIC COMPRESSION ABDOMINO-PELVIC COMPRESSION Nutcracker Syndrome - Diagnosis Nutcracker Syndrome z Anterior Nutcracker z Posterior Nutcracker z Evaluate the left renal vein for aorto-mesenteric compression 9 Compression between
    [Show full text]
  • The Urinary System Dr
    The urinary System Dr. Ali Ebneshahidi Functions of the Urinary System • Excretion – removal of waste material from the blood plasma and the disposal of this waste in the urine. • Elimination – removal of waste from other organ systems - from digestive system – undigested food, water, salt, ions, and drugs. + - from respiratory system – CO2,H , water, toxins. - from skin – water, NaCl, nitrogenous wastes (urea , uric acid, ammonia, creatinine). • Water balance -- kidney tubules regulate water reabsorption and urine concentration. • regulation of PH, volume, and composition of body fluids. • production of Erythropoietin for hematopoieseis, and renin for blood pressure regulation. Anatomy of the Urinary System Gross anatomy: • kidneys – a pair of bean – shaped organs located retroperitoneally, responsible for blood filtering and urine formation. • Renal capsule – a layer of fibrous connective tissue covering the kidneys. • Renal cortex – outer region of the kidneys where most nephrons is located. • Renal medulla – inner region of the kidneys where some nephrons is located, also where urine is collected to be excreted outward. • Renal calyx – duct – like sections of renal medulla for collecting urine from nephrons and direct urine into renal pelvis. • Renal pyramid – connective tissues in the renal medulla binding various structures together. • Renal pelvis – central urine collecting area of renal medulla. • Hilum (or hilus) – concave notch of kidneys where renal artery, renal vein, urethra, nerves, and lymphatic vessels converge. • Ureter – a tubule that transport urine (mainly by peristalsis) from the kidney to the urinary bladder. • Urinary bladder – a spherical storage organ that contains up to 400 ml of urine. • Urethra – a tubule that excretes urine out of the urinary bladder to the outside, through the urethral orifice.
    [Show full text]
  • Variation in the Origin of the Testicular Arteries and Drainage of the Right Testicular Vein
    Int. J. Morphol., 29(2):614-616, 2011. Variation in the Origin of the Testicular Arteries and Drainage of the Right Testicular Vein Variación en el Origen de las Arterias Testiculares y el Drenaje de la Vena Testicular Derecha *Royana Singh; **Amit Jaiswal; *S. N. Shamal & ***S. P. Singh SINGH, R.; JAISWAL, A.; SHAMAL, S. N. & SINGH, S. P. Variation in the origin of the testicular arteries and drainage of the right testicular vein. Int. J. Morphol., 29(2):614-616, 2011. SUMMARY: During routine dissection of a 42 year old male Indian cadaver posterior abdominal wall, variations in the testicular vessels were observed. The right testicular artery arose from the right accessory renal artery, which originated from the ventral aspect of the abdominal aorta. The left testicular artery originated from the ventral aspect of the aorta in almost the same horizontal line as the right accessory renal artery, just below the superior mesenteric artery and 1.79 cm, above the origin of the renal arteries. The right vein drained into the right accessory renal vein instead of the inferior vena cava, while the left testicular vein drained into the left renal vein. The presence of variation of both the testicular arteries as well as the testicular vein is seldom seen together. KEY WORDS: Accessory Renal Artery; Renal artery; Renal vein; Testicular artery; Testicular Vein. INTRODUCTION MATERIAL AND METHOD The testicular arteries arise from the ventral aspect During the routine dissection of 10 cadavers for the of the abdominal aorta below the renal artery at the level of undergraduate classes, a 42 year old male cadaver of Indian the second lumbar vertebra.
    [Show full text]
  • (A) Adrenal Gland Inferior Vena Cava Iliac Crest Ureter Urinary Bladder
    Hepatic veins (cut) Inferior vena cava Adrenal gland Renal artery Renal hilum Aorta Renal vein Kidney Iliac crest Ureter Rectum (cut) Uterus (part of female Urinary reproductive bladder system) Urethra (a) © 2018 Pearson Education, Inc. 1 12th rib (b) © 2018 Pearson Education, Inc. 2 Renal cortex Renal column Major calyx Minor calyx Renal pyramid (a) © 2018 Pearson Education, Inc. 3 Cortical radiate vein Cortical radiate artery Renal cortex Arcuate vein Arcuate artery Renal column Interlobar vein Interlobar artery Segmental arteries Renal vein Renal artery Minor calyx Renal pelvis Major calyx Renal Ureter pyramid Fibrous capsule (b) © 2018 Pearson Education, Inc. 4 Cortical nephron Fibrous capsule Renal cortex Collecting duct Renal medulla Renal Proximal Renal pelvis cortex convoluted tubule Glomerulus Juxtamedullary Ureter Distal convoluted tubule nephron Nephron loop Renal medulla (a) © 2018 Pearson Education, Inc. 5 Proximal convoluted Peritubular tubule (PCT) Glomerular capillaries capillaries Distal convoluted tubule Glomerular (DCT) (Bowman’s) capsule Efferent arteriole Afferent arteriole Cells of the juxtaglomerular apparatus Cortical radiate artery Arcuate artery Arcuate vein Cortical radiate vein Collecting duct Nephron loop (b) © 2018 Pearson Education, Inc. 6 Glomerular PCT capsular space Glomerular capillary covered by podocytes Efferent arteriole Afferent arteriole (c) © 2018 Pearson Education, Inc. 7 Filtration slits Podocyte cell body Foot processes (d) © 2018 Pearson Education, Inc. 8 Afferent arteriole Glomerular capillaries Efferent Cortical arteriole radiate artery Glomerular 1 capsule Three major renal processes: Rest of renal tubule 11 Glomerular filtration: Water and solutes containing smaller than proteins are forced through the filtrate capillary walls and pores of the glomerular capsule into the renal tubule. Peritubular 2 capillary 2 Tubular reabsorption: Water, glucose, amino acids, and needed ions are 3 transported out of the filtrate into the tubule cells and then enter the capillary blood.
    [Show full text]