Ultrasonic findings of fetal axillary lymphangioma with intralesional hemorrhage.

We report a case of an axillary lymphangioma in a fetus delivered at 30 weeks' gestation with suspected intralesional hemorrhage based on the ultrasonic findings. In the ultrasonic examination at 15 weeks' gestation, the fetus was found to have a multilocular mass spreading from the axilla to the chest wall, which was diagnosed as an axillary lymphangioma. Chromosome analysis by amniocentesis showed a normal karyotype, and no other malformations were observed. At 29 weeks, the mass had increased in size, and color Doppler ultrasound examination revealed that the middle cerebral artery peak systolic velocity (MCA-PSV) reached 80.2 cm/s [1.86 MoM (multiples of the median)]. Intralesional bleeding was suspected because of the multiple images of hemorrhage in which sites of blood spouting in a pulsatile fashion were detected within the mass. Cordocentesis at 30 weeks revealed that fetal hemoglobin concentration was 5.1 g/dL. An emergency Cesarean section was performed. A female weighing 2810 g, including the mass, was delivered, and the blood hemoglobin level was 5.9 g/dL at birth. Blood transfusion, fine-needle aspiration of the fluid in the mass, intralesional injection of OK-432, and partial excision of the lymphangioma were performed after birth. Ultrasonic examination proved useful in the diagnosis of intralesional bleeding in this lymphangioma.

Frequency, anatomical properties and innervation of axillary arch and its relation to the brachial plexus in human fetuses.

PURPOSE: "Axillary Arch" (AA) is the main musculotendinous variation of the axillary region. The aim of this study was to reveal the frequency, anatomical properties, and innervation of AA and its relation with brachial plexus in human fetuses. METHODS: In this study, 50 human fetuses (male: 20, female: 30), gestation age varied between 16 and 38 weeks (mean ± SD: 23.3 ± 5.3 week), were dissected at the anatomy laboratory of Mersin University, Faculty of Medicine. RESULTS: AA was found in 11 of the 50 fetuses, and in 3 of 11, it was bilateral. Among both sides, 6 of 14 AAs were on the right and 8 were on the left side. Seven of AA's (7% of the specimens) were in muscular and 7 (7%) of them were in musculotendinous structure. With regard to Testut's classification, six (6%) of them were of complete type, six (6%) were incomplete and two (2%) were concordant with both types. Three different types of AA were defined considering the shapes of the arches. According to our classification, seven of the AAs were of type 1, two of them were of type 2 and five of them were of type 3. Additionally, the incidence of the T2 spinal nerve joining the brachial plexus was significantly higher in the specimens with AA (p = 0.001). CONCLUSIONS: Each type of AA described in this study is thought to have individual clinical significance. Being aware of AA and its types can be important to determine a safe approach to the axillary region for surgeons. In addition, our results show the relation between the occurrence of AA and the variations in the formation of the proximal part of brachial plexus.

Brachial plexus variations in human fetuses.

OBJECTIVE: We examined the anatomic variations of the brachial plexus (BP) in human fetuses. METHODS: This study was performed with 200 BPs from spontaneously aborted fetuses without detectable malformations. The plexuses were dissected, and the normal position and/or morphological variations of the BP were determined and photographed. RESULTS: There were no variations in 93 plexuses, and 107 plexuses were observed to have different variations. Morphological variations were observed more frequently among female fetuses and right sides. The BPs were composed mostly of the C5, C6, C7, and C8 nerves and the T1 nerve (71.5%). A prefixed plexus was observed in 25.5% of cases, and a postfixed plexus was observed in 2.5% of cases. In one case (0.5%), the C4 and T2 nerves joined the formation. The inferior trunk was not formed in 9% of cases. The superior trunk was not formed in 1% of cases. In one plexus, the superior trunk was formed by the ventral rami of the C4 and C5 nerves. In one case, the inferior trunk was formed by the ventral rami of the T1 and T2 nerves. Division variations were observed most frequently. There were also variations in the terminal branches, such as the roots of the median nerve joining in the distal part of the arm (8.5%), the axillary nerve being separate from the posterior division of the superior trunk (2.5%), and a connection existing between the median and musculocutaneous nerves (1%). CONCLUSION: Knowledge of BP variations is important for surgeons who perform surgical procedures in the cervical and axillary regions.