Absent celiac trunk and unusual arterial anatomy of the upper abdomen: into the deep.

The celiac trunk is the first major branch of the abdominal aorta. It originates from the ventral aspect of the aorta at the level of T12-L1 vertebrae and was originally described as an artery that branches into the common hepatic artery, left gastric artery, and splenic artery. Absence of the celiac trunk and origin of the three arteries separately from the aorta is a rare entity that is reported in 0.38% to 2.6% of cases. It is even more uncommon that this variation can be accompanied by other vascular variations of the upper abdomen as accessory arteries to the liver, stomach, and pancreas. These cases arise during embryogenesis due to decreased arterial degeneration combined with decreased arterial fusion, which results in the anatomical variations present in the current case. Complex arterial variations are both a risk for iatrogenic injury during surgical procedures and beneficial during endovascular supply as they may provide additional access for embolization and chemotherapy.

Giant epiphrenic diverticulum: a challenging case / Divertículo epifrénico gigante: un caso desafiante

A diverticulum is a limited saccular protrusion of the esophageal wall, communicating with its lumen. Anatomically, esophageal diverticula are classified into pharyngoesophageal, median, and epiphrenic. Treatment of esophageal diverticula is based on several basic pathophysiological principles. Small and asymptomatic diverticula do not require specific treatment. Large and symptomatic diverticula require surgical intervention, consisting of diverticulectomy combined with myotomy. Operations for symptomatic epiphrenic diverticula make up no more than 2% of all operations on the esophagus. We describe a case of an epiphrenic diverticulum with the dimensions 88x60x90 mm in a 54-year-old patient. Surgical treatment of this disease was performed according to the Lewis method. The article also describes methods of dealing with concomitant postoperative complications and a brief review of the literature on epiphrenic diverticula (AU)

Un divertículo es una protuberancia sacular limitada de la pared esofágica, que se comunica con su luz. Anatómicamente, los divertículos esofágicos se clasifican en faringoesofágicos, medianos y epifrénicos. El tratamiento de los divertículos esofágicos se basa en varios principios fisiopatológicos básicos. Los divertículos pequeños y asintomáticos no requieren tratamiento específico. Los divertículos grandes y sintomáticos requieren intervención quirúrgica, que consiste en diverticulectomía combinada con miotomía. Las operaciones por divertículos epifrénicos sintomáticos representan no más del 2% de todas las operaciones en el esófago. Describimos un caso de divertículo epifrénico de dimensiones 88x60x90 mm en un paciente de 54 años. El tratamiento quirúrgico de esta enfermedad se realizó según el método de Lewis. El artículo también describe métodos para tratar las complicaciones posoperatorias concomitantes y una breve revisión de la literatura sobre divertículos epifrénicos (AU)

Spleen: an organ of multiple shapes

Introduction: The spleen is located in the upper part of the abdominal cavity. As an organ, the spleen can have various shapes and size. Material and methods: The human spleen was studied in 273 cadavers (154 men and 119 women) who did not have diseases of the spleen. The shape of the spleen was analyzed based on splenic index, Michels classification. Results: The most common shape of the spleen in men is the elongated one. It was encountered in 79 (51.3%) cases out of 154. In women, the most common shape was the intermediate. It was encountered in 51 (42.9%) of the 119 cases. Based on Michels classification the clinoid (wedge) shape was encountered in 102 (37.74%) cases, triangular in 59 (21.83%) and tetrahedral in 30 (11.1%). In 30.26% the shape of the spleen couldn’t be classified according to Michels classification. In 21 cases (7.77%) the spleen had a flat shape; in 27 (9.99%) – dome-shaped; in 1 case (0,37%) – Z-shape; in 18 (6.66%) – round shape; in 6 (2.22%) – irregular shape; in 2 (0.66%) - shape with a node in the hilum; in 1 (0,37%) – rhomboid shape, in 2 (0,74%) – bilobed shape and in 4 cases (1,48%) – lobular shape. The splenic fissures located on the upper edge of the organ were found in 81 (29.91%) cases, and also on the lower edge - in 41 (14.02%) cases. In 13 (4.67%) cases fissures were encountered on both sides. In 148 (51.4%) cases the spleen had no fissures on its surface. Conclusions: The spleen has various shapes beyond the classical wedge, triangular and tetrahedral. All of these shapes do not represent a pathological finding but in certain situation may require further analysis and interpretation depending on the imaging technique and experience of the physician. (AU)

Introducción: el bazo se localiza en la parte superior de la cavidad abdominal. Como órgano, el bazo puede tener varias formas y tamaños. Material y métodos: Se estudió el bazo humano en 273 cadáveres (154 hombres y 119 mujeres) que no tenían enfermedades del bazo. La forma del bazo se analizó con base en el índice esplénico, clasificación de Michels. Resultados: La forma más común del bazo en los hombres es la alargada. Se encontró en 79 (51,3%) casos de 154. En las mujeres, la forma más común fue la intermedia. Se encontró en 51 (42,9%) de los 119 casos. Según la clasificación de Michels, la forma clinoide (cuña) se encontró en 102 (37,74%) casos, triangular en 59 (21,83%) y tetraédrica en 30 (11,1%). En un 30,26%, la forma del bazo no se pudo clasificar según la clasificación de Michels. En 21 casos (7,77%) el bazo tenía forma plana; en 27 (9,99%) - en forma de cúpula; en 1 caso (0,37%) - forma de Z; en 18 (6,66%) - forma redonda; en 6 (2,22%) - forma irregular; en 2 (0,66%) - forma con un nodo en el hilio; en 1 (0,37%) - forma romboide, en 2 (0,74%) - forma bilobulada y en 4 casos (1,48%) - forma lobular. Las fisuras esplénicas ubicadas en el borde superior del órgano se encontraron en 81 (29,91%) casos, y también en el borde inferior, en 41 (14,02%) casos. En 13 (4,67%) casos se encontraron fisuras en ambos lados. En 148 (51,4%) casos el bazo no presentaba fisuras en su superficie. Conclusiones: El bazo tiene varias formas más allá de la clásica cuña, triangular y tetraédrica. Todas estas formas no representan un hallazgo patológico, pero en determinadas situaciones pueden requerir un mayor análisis e interpretación según la técnica de imagen y la experiencia del médico. (AU)

Posterior midline cleft of the atlas – a crucial anatomical variation in vertebral fractures / Hendidura posterior de la línea media del atlas - una variación anatómica crucial en las fracturas vertebrales

The anatomy of the first vertebra, namely atlas, has significant clinical implications. Atlas is situated between the occipital bone and the second cervical vertebra (axis) and is one of the main points of head movement. Most congenital anomalies of the vertebra are diagnosed incidentally during imaging investigations and can be associated with cervical spine anomalies. The neurological symptoms may include weakness in the four limbs, acute neurologic deficits such as transient quadriparesis, paraparesis, Lhermitte's sign, chronic neck pain, and headache. This anomaly is also commonly seen in gonadal dysgenesis, Klippel-Feil syndrome, Arnold-Chiari malformations, and Turner and Down syndrome. Unlike other variations, which arise due to disturbances of ossification posterior midline clefts of the atlas, are different since they are a developmental failure of chondrogenesis. We therefore present an anatomical case and analysis of the literature about posterior arch clefts of atlas. (AU)

La anatomía de la primera vértebra, a saber, el atlas, tiene importantes implicaciones clínicas. Atlas está situado entre el hueso occipital y la segunda vértebra cervical (axis) y es uno de los principales puntos de movimiento de la cabeza. La mayoría de las anomalías congénitas de las vértebras se diagnostican de manera incidental durante las investigaciones por imágenes y pueden asociarse con anomalías de la columna cervical. Los síntomas neurológicos pueden incluir debilidad en las cuatro extremidades, déficits neurológicos agudos como cuadriparesia transitoria, paraparesia, signo de Lhermitte, dolor de cuello crónico y dolor de cabeza. Esta anomalía también se observa con frecuencia en la disgenesia gonadal, el síndrome de Klippel-Feil, las malformaciones de Arnold-Chiari y el síndrome de Turner y Down. A diferencia de otras variaciones, que surgen debido a alteraciones de la osificación, las hendiduras de la línea media posterior del atlas, son diferentes ya que son una falla en el desarrollo de la condrogénesis. Por tanto, presentamos un caso anatómico y un análisis de la literatura sobre las hendiduras del arco posterior del atlas. (AU)

Spontaneous Pneumomediastinum ­ a Rare Asthma Complication.

Asthma is the most common chronic respiratory disease worldwide and its prevalence is increasing. Acute asthma complications are often the reason for admission to emergency healthcare service. In our article we present a case of a rare asthma complication ­ spontaneous pneumomediastinum with a short review of its incidence, etiology, diagnosis and management. Spontaneus pneumothorax is important to differentiate with secondary pneumomediastinum as well as other conditions as cardiac diseases (acute coronary syndrome, pericarditis, cardiac tamponade, pneumopericardium), lung diseases (pneumothorax, pulmonary embolism, tracheobronchial tree rupture), musculoskeletal disorders, and diseases of the esophagus (rupture and perforation o the esophagus). A chest X-ray is often reliable for diagnosis of spontaneous pneumomediastinum and when inconclusive, can be followed by CT. The management is usually conservative with oxygen and analgesia. Surgery is required only in cases of tracheobronchial compression.