Bilateral Lateral Costal Branches of the Internal Thoracic Arteries: A Case Report.

We report a case of bilateral lateral costal branches (LCB) of the internal thoracic artery (ITA). On the left side, the ITA branched from the subclavian artery as a common trunk with the thyrocervical trunk. The left LCB flew into the collateral branch of the fifth intercostal artery after reaching the upper end of the sixth rib and after exiting the left ITA at the upper part of the first rib. The left ITA was disconnected near the second rib because it had been used for coronary artery bypass surgery. The right ITA arose from the anterior surface of the right subclavian artery just after the right ITA diverged from the brachiocephalic artery. The right LCB reached the upper end of the fifth rib and flew into the collateral branch of the fourth intercostal artery. The right ITA descended along the back of the costal cartilages as usual. The mechanism of the development of the LCB is thought to be due to a lateral longitudinal anastomosis connecting the inter-node arteries arising from the dorsal aorta during the embryonic phase. More anatomical and embryological studies are necessary to further elucidate this variant arterial branch.

Extrapulmonary sequestration with a left internal thoracic arterial feeding vessel in an infant treated with video-assisted Thoracoscopic resection: a case report.

BACKGROUND: Congenital lung malformations exist along a spectrum of pathogenesis and disease severity. Extrapulmonary sequestration (EPS), in which nonfunctional lung tissue develops without connection to the tracheobronchial tree, is one rare manifestation of this disease. Atypical vascular anatomy with a systemic feeding vessel characterizes these lesions. CASE PRESENTATION: A 3 day old, 37 week gestation infant underwent chest X-ray for confirmation of umbilical catheter placement and was found to have an elevated left hemidiaphragm consistent with eventration versus congenital diaphragmatic hernia. He remained asymptomatic and was evaluated as an outpatient at the age of 9 months, where CT angiogram demonstrated extrapulmonary versus intrapulmonary sequestration with a systemic feeding vessel from the left internal mammary artery. CONCLUSIONS: It is exceedingly rare for the feeding artery to arise from the internal mammary; two such cases have been reported to date, both in adult patients. Here we present a third case of EPS with arterial supply from the internal mammary successfully treated with video-assisted thoracoscopic resection in a 9 month old infant.

Incidental discovery of a new and clinically important anatomic variant of the internal thoracic artery in a young male trauma patient.

The internal thoracic artery (ITA) is the largest thoracic wall artery and is clinically important primarily for use in coronary artery bypass grafting. A number of anatomic variants of the ITA have been reported; however, bilateral, aberrant lateral branches of the ITA never have. The importance of this finding lies in the positioning of the artery at a potential chest tube insertion site. Here, we report the identification, on CT scan, of this rare variation in a young male trauma patient.

Fistula of right internal thoracic artery as a rare cause of chest pain.

Variation in the origin of the internal thoracic arteries has been previously described and reported in the literature; however, there has been no report of an anomalous termination of the right internal thoracic artery into the pulmonary vein persisting and presenting in adult life. We report the case of the right internal thoracic artery originating from the first part of subclavian artery but terminating into the right superior pulmonary vein that presented during the third decade of life.

Giant Chest Wall Arteriovenous Malformation: A Case Report and Literature Review.

BACKGROUND: We present an interesting case of a 55-year-old male with a large left chest mass after significant cutaneous bleeding. Computed tomography angiogram of the chest revealed arteriovenous malformation with blood supply from sub-branches of the left subclavian artery, left internal mammary artery, and left external carotid artery. Measuring 5.0 × 14.0 × 10.8 cm, the mass extended superior to the clavicle and inferior to the third rib with medial and lateral borders at the level of the clavicular head and coracoid, respectively. METHODS: Arteriovenous malformations (AVMs) are characterized by abnormal connections between arteries and veins which bypass the capillary system. Often small and asymptomatic, large AVMs can be painful, prone to bleeding and, if large enough, interfere with activities of daily living. While described involving various parts of the body, most notably in the central nervous system, there is a paucity of literature involving chest wall AVMs. RESULTS: Using a staged, multidisciplinary approach, treatment began with an endovascular exclusion of the arterial blood supply, which involved a combination of coil embolization and stent exclusion of feeder vessels. Two days postembolization, the patient underwent an en bloc resection of affected portion of his chest wall. Reconstruction was completed with a combination rotational flap and split-thickness skin graft. Following the procedures, the patient had an uncomplicated recovery. Three years following procedure, he has no signs of recurrence of his AV malformation. CONCLUSION: Surgical planning and indications for giant arteriovenous malformations remains a unique and difficult problem. The complex anatomy and extreme rarity of a chest wall AVM requires a multidisciplinary staged approach but can be treated with a multistage, multidisciplinary surgical approach with satisfactory and long-lasting results.

Internal mammary artery-to-pulmonary vasculature fistula: Systematic review of case reports.

The formation of a fistula between the internal mammary artery and the pulmonary vasculature (IMA-to-PV) is a rare anomaly. The etiology can be congenital; however, most recent cases have been associated with coronary artery bypass grafting, trauma, inflammatory conditions, chronic infections, or neoplasia. The knowledge base on the formation of these fistulas is derived primarily from case reports. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage these cases, and the treatment of an IMA-to-PV fistula is controversial. To our knowledge, this report is the first to review 80 cases of IMA-to-PV fistulas reported in the literature. We describe the etiologies, clinical presentation, and management of these fistulas.

Anomalous Right Internal Thoracic Artery Terminating in the Right Superior Pulmonary Vein.

Variation in the origin of the internal thoracic arteries has been previously described and reported in the literature; however, there has been no report of an anomalous termination of the right internal thoracic artery (RITA) in the pulmonary vein persisting and presenting in adult life. We report the case of a right internal thoracic artery originating from the first part of the subclavian artery but terminating in the right superior pulmonary vein that presented during the third decade of life.

Endovascular treatment of inadvertent left internal mammarian artery to great cardiac vein fistula.

Inadvertent left internal mammarian artery to coronary sinus anastomosis is a rare complication of coronary artery by-pass graft surgery. Management of this iatrogenic complication is controversial with conservative, surgical and endovascular options possible. Endovascular treatment offers a minimally invasive approach with a wide variety of embolic agents with different success rates. Herein we present a case of an iatrogenic left internal mammarian artery to coronary sinus anastomosis treated by detachable coil embolization. Use of detachable coil offers more precise deployment that is essential in the treatment of an iatrogenic left internal mammarian artery to coronary sinus anastomosis which can present challenges due to high flow rates and coil migration.

Synovial Sarcoma-AV Malformation Collision in the Anterior Mediastinum.

Arteriovenous malformation (AVM) and synovial sarcomas are both rare lesions in the mediastinum. Rarer still is a collision tumor in that region. Herein we present a case of a collision tumor comprised of AVM and synovial sarcoma in a 76-year-old man, presenting with pneumonia. Imaging showed a vascular lesion that spontaneously ruptured, causing enlargement of the mass and hemothorax. The resected specimen revealed the malignant second component. This report is a discussion of the never-before reported lesion.

Minimally invasive fetal therapy for hydropic lung masses: three different approaches and review of the literature.

OBJECTIVE: To report three different antenatal therapeutic approaches for fetal lung masses associated with hydrops. METHODS: Three prospectively followed cases are described, and all 30 previously published minimally invasive cases of fetal therapy for hydropic lung masses are reviewed. RESULTS: Three hydropic fetuses with large intrathoracic lung masses presented at 17, 25 and 21 weeks of gestation, respectively. An aortic feeding vessel was identified in each case and thus a bronchopulmonary sequestration (BPS) was suspected. Under ultrasound guidance, the feeding vessel was successfully occluded with interstitial laser (Case 1), radiofrequency ablation (RFA) (Case 2) and thrombogenic coil embolization (Case 3). Complete (Cases 1 and 2) or partial (Case 3) resolution of the lung mass and hydrops was observed. A healthy infant was born at term after laser therapy (Case 1), and the involved lung lobe was resected on day 2 of postnatal life. In Case 2, hydrops resolved completely following RFA, but an iatrogenic congenital diaphragmatic hernia and abdominal wall defect became apparent 4 weeks later. The neonate died from sepsis following spontaneous preterm labor at 33 weeks. In Case 3, despite technical success in complete vascular occlusion with coils, a stillbirth ensued 2 days after embolization. CONCLUSIONS: The prognosis of large microcystic or echogenic fetal chest masses associated with hydrops is dismal. This has prompted attempts at treatment by open fetal surgery, with mixed results, high risk of premature labor and consequences for future pregnancies. We have demonstrated the possibility of improved outcome following ultrasound-guided laser ablation of the systemic arterial supply. Despite technical success, RFA and coil embolization led to procedure-related complications and need further evaluation.

Congenital anastomosis between left anterior mammary and pulmonary vasculatures.

Several case reports have described the presence of acquired fistula connecting the left internal mammary artery to the pulmonary vasculature; however, occurrence of this type of congenital fistulas is less common. The authors present a case of a congenital left internal mammary artery-pulmonary vasculature fistula that was incidentally found during a coronary angiography in a patient who was being evaluated for coronary artery bypass surgery. The particulars of the case are discussed, and the literature is reviewed.

Anomalous Origin of Left Internal Thoracic Artery from the Second Intercostal Artery / Origen Anómalo de la Arteria Torácica Interna Izquierda desde la Segunda Arteria Intercostal

Left internal thoracic artery (LITA) has increased importance and common use in coronary bypass grafting because of long-term better patency rate and improvement in both the duration and quality of survival of patients. LITA is a branch of the first part of the subclavian artery. We report a case in which the LITA originated from the second left intercostal artery. A 71-year-old man with a history of angina pectoris for 1 month was admitted to the hospital because of progressive increase in anginal symptoms. During the operation, it was noted that the LITA originated from the second intercostal artery. LITA used as a free graft. LITA was anastomosed to the left anterior descending coronary artery. He was free of symptoms 4 weeks after operation. To our knowledge, this is the first reported case of the LITA originating from the second intercostal artery.

La arteria torácica interna izquierda (ATII) ha aumentado en importancia en su uso como injerto de bypass coronario, debido a su mayor tasa de permeabilidad a largo plazo, y mejora tanto en la duración y la calidad de la supervivencia de los pacientes. La ATII es una rama de la primera parte de la arteria subclavia. Se presenta un caso, en el cual la ATII se originaba desde la segunda arteria intercostal izquierda. Un hombre de 71 años de edad, con antecedentes de angina de pecho durante 1 mes, fue ingresado en el hospital debido al aumento progresivo de los síntomas de angina. Durante la operación, se observó que la ATII se originaba a partir de la segunda arteria intercostal. La ATII fue utilizada como injerto libre, anastomosada a la arteria coronaria izquierda descendente anterior. El paciente se mostró libre de síntomas 4 semanas después de la operación. Este es el primer caso clínico reportado de la ATII originada desde la segunda arteria intercostal.