Computed tomography angiography study of the azygos vein course and termination into superior vena cava: gender and age impact.

PURPOSE: The study highlights azygos vein (AV) topography, arrangement and confluence morphometry in dyspnoea and tachycardia patients of extrapulmonary and extracardiac aetiology. METHOD: Computed-tomography angiography of 25 male and 26 female patients (mean age 66.5 years) were studied for: thoracic vertebral (T) height of AV- superior vena cava-SVC confluence, AV course and deviations from vertebral column (VC) midline, AV and SVC diameters, distance (AV arch- lower border of carina) and gender and age impact. RESULTS: Commonest heights of the AV-SVC confluence were T5 (56.9%), T4 (31.4%), T6 (9.8%) and T3 (2%). The AV terminated into SVC after crossing the left side of VC midline in 56.9%, slightly deviated right of the midline in 37.3% and coursed right of VC in 5.9%. Mean AV and SVC diameters were 0.96 ± 0.18 cm and 1.86 ± 0.27 cm. Male predominance in AV and SVC diameters and a slight AV diameter significant increase with the age were found. The (AV highest point-lower border of carina) mean distance was 2.05 ± 0.44 cm and male predominance existed. CONCLUSION: The commonest termination height of the AV was T5, while T3 was the rarest one. Aging induces the AV leftward displacement, while gender had no impact. AV and SVC diameters had higher significant values in males, while ageing had a significant impact only in AV diameter. The AV higher diameters will be used as predictors for higher values of SVC diameter and mediastinum pathology. Such findings can be useful in mediastinal surgery, mediastinoscopy and surgery of VC deformations, neurovascular surgery of retroperitoneal organs, disc herniation and T fractures.

What is the history of the term "azygos vein" in the anatomical terminology?

The term "azygos vein" is in common use in modern anatomical and cardiovascular textbooks to describe the vein which ascends to the right side of the vertebral column in the region of the posterior mediastinum draining into the superior vena cava. "Azygos" in Greek means "without a pair", explaining the lack of a similar vein on the left side of the vertebral column in the region of the thorax. The term "azygos" vein was utilized firstly by Galen and then was regenerated during Sylvius' dissections and Vesalius' anatomical research, where it received its final concept as an official anatomical term. The purpose of this study is to highlight the origin of the term "azygos vein" to the best of our knowledge for the first time and its evolution from the era of Hippocrates to Realdo Colombo.

Myocardial bridge over the left anterior descending coronary artery: A case report and review of the literature.

Myocardial bridging (MB) is considered as a topic of high interest since its occurrence in different studies is statistically significant, and the clinical manifestations of this phenomenon are complicated with cardiovascular diseases. Whether the MB participates in heart diseases and has a decisive effect to life-threatening situations is still under research, and many studies have been conducted to clarify the abovementioned question. A case report with a MB on the left anterior descending coronary artery is presented in the current study, and a review of the literature is provided as well. Cardiologists as well thoracic surgeons and radiologists should bear in their mind the potential presence of such variant during interpretation of angiographies and multidetector-computed tomography.

Abnormal Origin and Course of the Accessory Phrenic Nerve: Case Report.

In the current cadaveric study an unusual sizeable accessory phrenic nerve (APN) was encountered emerging from the trunk of the supraclavicular nerves and forming a triangular loop that was anastomosing with the phrenic nerve. That neural loop surrounded the superficial cervical artery which displayed a spiral course. The form of a triangular loop of APN involving the aforementioned artery and originating from the supraclavicular nerve to the best of our knowledge has not been documented previously in the literature. The variable morphological features of the APN along with its clinical applications are briefly discussed.

Association of Tortuous Common Carotid Artery with Abnormal Distribution of the Ansa Cervicalis: A Case Report.

In the current study, we display a rare association of an aberrant innervation of the sternocleidomastoid muscle by the ansa cervicalis (AC) with a tortuous common carotid artery (TCCA). In specific, in a male cadaver we observed on the right side of the cervical region, a nerval branch of remarkable size originating from the most distal part of the AC's superior root and after piercing the superior belly of the omohyoid muscle innervated the distal portion of the sternocleidomastoid muscle. Furthermore, we noticed a tortuous course of the initial part of the right common carotid artery. We discuss the surgical significance of the awareness of AC's variations during neurotisation of the recurrent laryngeal nerve in cases of its damage, as well as the importance of aberrant innervation of the sternocleidomastoid muscle by AC for the preservation of muscle's functionality after accessory nerve's damage. Furthermore, we highlight the fact, that the knowledge of the relatively uncommon variant, such as TCCA is crucial for the physician in order to proceed more effectively in differential diagnosis of a palpable mass of the anterior cervical region or deal with symptoms such as dyspnea, dysphagia or symptoms of cerebrovascular insufficiency.

Bilothorax Associated with Bile Peritonitis in a Dog with No Diaphragmatic Disruption: A Case Report.

A 4-year-old intact male mixed-breed dog was presented with vomiting and severe depression of 6-day duration after being struck by a car 2 weeks before presentation. Clinical examination revealed hypothermia, respiratory difficulty, jaundice, and a bicavitary (pleural and peritoneal) effusion. Hematological and biochemical abnormalities included neutrophilic leukocytosis, increased total bilirubin concentration, and increased serum lipase activity. Biochemical and cytological evaluation of both abdominal and thoracic fluids were suggestive of bilious effusions. During celiotomy, a rupture of the cystic duct was observed, which necessitated cholecystectomy. A diaphragmatic rupture was not found. A thoracostomy tube was inserted in the right pleural space, and continuous suction was maintained for 48 hours. The dog was discharged 20 days after surgery and no abnormalities were detected on either blood tests or ultrasonographic examinations of the thorax and abdomen on follow-up examination 7 months after surgery. The presence of a bilothorax should be considered in animals with bile peritonitis, grossly intact diaphragm and pleural effusion. The exact mechanisms of the development of bilothorax are unclear, but the transport of bile through microscopic congenital or acquired weaknesses or defects of the diaphragm, via abdominal lymphatics penetrating the diaphragm and draining into the thoracic lymphatics represent the most probable route.

Congenital Synostosis of Cervical Vertebrae: An Osteological Study and Review of the Literature.

Introduction The possible appearance of congenital fusion of the second cervical vertebra with adjacent cervical vertebrae, along with its epidemiology, embryological development, and clinical manifestations, was the aim of the current study. Methods The osteological material of 93 dried second cervical vertebrae of both sexes were examined in order to identify the likely presence of congenital fusion with the neighboring vertebrae. Results Among 93 axes, we identified one case of a congenitally fused second cervical vertebrae with the third and fourth cervical vertebrae, which accounted for a frequency of 1.08%. There was an incomplete fusion of the vertebral bodies and almost complete fusion of the laminae and facet joints. Conclusion The knowledge of such rare vertebral synostosis is crucial for the neurosurgeon, orthopedist, and physician dealing with the cervical spine, as well as the anesthetist when performing procedures, such as endotracheal intubation.

A Case of Abnormal Origin of the Azygos Vein System: An Anatomical Study in a Human Cadaver.

The azygos vein (AV) system is considered a venous system which displays great variability in its formation and course. Especially, regarding the origin of the AV system, the international literature describes mostly the union of the ascending lumbar with the subcostal veins, though other origins are documented as well. The current study displays an abnormal origin of the azygos system, which to the best of our knowledge has never been described before.

Costoclavicular Joint: An Osteological Study on Clavicles with Clinical Relevance.

Introduction The current study aims to detect the incidence of occurrence of a morphological variant of the impression for the costoclavicular ligament, that is a faceted apophysis of the clavicle which participates in the formation of an aberrant joint, the so-called costoclavicular joint. Methods A material of 208 dry clavicles, 107 of right and 101 of left side derived from an osteological collection, was examined in order to detect the likely presence of facet apophysis at the clavicular area of impression for the costoclavicular ligament. Results We observed three cases of oval-shaped faceted apophysis, thus an incidence of 1.44%, two in right clavicles and one in left clavicle. Conclusion The awareness of such a rare joint, thus the costoclavicular joint, is important for the physician, since such a joint may be mistaken for occupying space lesion, induce pain when it is osteoarthritic and decrease the costoclavicular space leading to difficulties in subclavian vein catheterization.

Neural Loop by the Median Nerve's Roots Associated with Multiple Neurovascular Anomalies: A Cadaver-based Case Report with Clinical Aspects.

The existence of a combination of neural and vascular variations in the axilla and arm region are relatively common. In the current case study, an association of a neural loop by the roots of the left median nerve along with an ipsilateral proximal division of the brachial artery in the upper arm and bilateral communications between the median and musculocutaneous nerves is documented. The morphological features of these abnormalities, along with the clinical implications induced during nerve blocks and surgical interventions in the region, are discussed as well.

The Anatomist James Douglas (1675-1742): His Life and Scientific Work.

James Douglas (1675-1742) is considered one of the most important anatomists of the eighteenth century; he introduced meticulous and scientific methods for studying human anatomy. He is known for the "pouch of Douglas," but his contribution is much more important. He deepened our knowledge of the anatomy of the peritoneum, located new muscles, and evolved the already recorded knowledge in a way that it could be implemented in surgery. Furthermore, he was such a famous obstetrician that even the Pope of his era admired him for his charisma.

A Left-sided Azygos Vein in a Cadaver: Anatomical and Surgical Considerations.

Despite the wide-spread knowledge among anatomists and surgeons that the azygos vein lies on the right side of the vertebral column, various scientific works have been conducted which suggest the existence of left-sided azygos veins. The displacement of the vessel seems to be related with aging, due to crossover veins and the development of osteophytes on the thoracic vertebrae. The current case report confirms the variation of the azygos vein's course, highlights the awareness of the relatively unusual left-sided location of the azygos vein for the surgeon of the region, and underlines the clinical significance of such knowledge to the modern internist-radiologist, general surgeon and thoracic surgeon, as well.

Lymphovenous Anastomoses Between Thoracic Duct and Azygos Vein in a Human Cadaver: A Case Report.

OBJECTIVE: The study adds valuable information regarding lymphovenous communications between the thoracic duct and the azygos vein, which are very rarely discovered during anatomical dissections and very few cases have been mentioned worldwide. A detailed description of our findings and a brief review of the relevant literature are also provided. CASE REPORST: In the current study, two sizeable obliquely directed lymphovenous anastomoses between the thoracic duct and the azygos vein at the midportion of the mediastinum are described in the same cadaver. CONCLUSION: The existence of such anastomoses in humans, as well in animals, is a scientific issue under debate. Cases of rapid cancer spread could be potentially explained by the likely presence of the abovementioned communications.

The Life and Work of Nikolai Ivanovich Pirogov (1810-1881): An Outstanding Anatomist and Surgeon.

Nikolai Ivanovich Pirogov is considered one of the most important anatomists and surgeons in the history of medicine. The Russian physician conducted more than 11,000 dissections and meticulously studied human anatomy, discovering important anatomical regions such as Pirogov's triangle. Pirogov developed surgical methods and techniques used by physicians for many decades such as Pirogov's amputation. Pirogov is also known for his contribution to war medicine, given his experience practicing medicine in the Crimean War as a surgeon, where he introduced innovative methods for the treatment of injured soldiers. Pirogov's most important contribution to the scientific community is his humanistic and democratic mentality-which he maintained until the end of his life-elements necessary for the evolution of every modern physician and scientist.

Unusual Origin of a Double Upper Subscapular Nerve from the Suprascapular Nerve and the Posterior Division of the Upper Trunk of the Brachial Plexus: A Case Report.

A double upper subscapular nerve on the right side was detected in a male cadaver, with the proximal one arising from the suprascapular nerve and the distal one from the posterior division of the upper trunk of the brachial plexus. Both of them penetrated and supplied the uppermost portion of the right subscapularis muscle. That anatomic variation was associated with a median nerve formed by two lateral roots. The origin and pattern of the upper subscapular nerve displays high variability, however the presented combination of the variable origin of a double upper subscapular nerve has rarely been described in the literature. The knowledge of such an anatomic variation is essential for the surgeon operating in the region especially in instances of brachial plexus' repair after any traumatic injury. Moreover, the awareness of the precise origin and topography of these nerves is important for the physician attempting to block these nerves or utilizing these nerves as grafts for neurotization of adjacent damaged nerves of the brachial plexus.

Accessory coracobrachialis muscle with two bellies and abnormal insertion - case report.

OBJECTIVE: In the current study a brief review is presented of the coracobrachialis muscle's morphological variability, action, embryological development and clinical significance. CASE REPORT: We report a case of a left-sided coracobrachialis muscle consisting of two bellies. The deep belly inserts into the usual site in the middle area of the anteromedial aspect of the left humerus, whereas the superficial belly inserts through a muscular slip into the brachial fascia and the medial intermuscular septum, forming a musculo-aponeurotic tunnel in the middle region of the left arm, for the passage of the median nerve, brachial artery and veins, medial antebrachial cutaneous nerve and ulnar nerve. CONCLUSION: Awareness of such a muscle variant should be kept in mind by physicians and surgeons during interpretation of neural and vascular disorders of the upper limb, since such a variant may potentially lead to entrapment neuropathy and/or vascular compression, predisposing to neurovascular disorders, as well as during preparation of that muscle in cases of utilizing it as a graft in reconstruction of defects.

Knowledge of the anatomy and physiology of the spleen throughout Antiquity and the Early Middle Ages.

The evolution of knowledge regarding the anatomy and physiology of the spleen throughout Antiquity and the Early Middle Ages is described, and general perceptions about this organ during different eras along this time line are presented. The original words of great physicians from the period of time stretching from Ancient Egypt to the Avicennan era are quoted and discussed to demonstrate how knowledge of the spleen has evolved and to present the theories that dominated each era. Furthermore, theories about illnesses relating to the spleen are reported, which show how this organ was perceived-in terms of its function and anatomy-during each era.

Bilateral Osseous Interclinoid Bridges Associated with Foramina of Vesalius: A Case Report.

The current study displays a very rare combination of ossified interclinoid ligaments at the sella turcica region associated with bilateral foramina of Vesalius. In a macerated skull four osseous bars interconnecting the clinoid processes bilaterally were detected. Specifically, two bilateral osseous bars were observed bridging the gap between the anterior and middle clinoid processes forming the so called caroticoclinoid foramen on each side and two additional osseous bridges linked the anterior and posterior clinoid processes, bilaterally. Furthermore, two distinct bilateral foramina of Vesalius were documented just anterior and medial to the foramen ovale. The awareness of the osseous sellar bridges is crucial for the physician and especially the neurosurgeon since their presence may complicate the removal of clinoid processes and induce damage of the internal carotid artery and oculomotor nerves. Furthermore, the likely existence of the foramen of Vesalius may lead to transfer of an infected thrombus into the cranial cavity and complicate a percutaneous trigeminal rhizotomy.

Aberrant innervation of the sternocleidomastoid muscle by the transverse cervical nerve: a case report.

Two aberrant rami originating from the right transverse cervical nerve and innervated the midportion of the sternocleidomastoid muscle (SM) were detected during routine cadaver dissection. Although SM is commonly innervated by the accessory nerve, as well as by cervical nerves, it is likely to be innervated additionally by other nerves such as hypoglossal nerve, ansa cervicalis, facial or external laryngeal nerve. Some considerations as regards the possible composition of the aberrant rami of the transverse cervical nerve detected in the current study, as well as the relevant literature is discussed.