Anatomical variant origin of suprarenal arteries from coeliac trunk development, and its clinical significance

Background: One of the most vascular organ in the body Adrenal gland being highly variant in vasculature and tough to approach, its knowledge needs to be updated regularly. Anatomists, Surgeons and Radiologists will be benefitted with this study and improves the quality of care provided to patients by reducing morbidity and mortality.Methods: This study was done on 48 formalin fixed cadavers (33 males, 15 females) in the department of anatomy, between 2014-2019. Coeliac trunk was skeletonized, and branches traced looking for suprarenal arterial branches.Results: Superior Suprarenal Artery originated from Inferior phrenic artery in 13(27%) cases, and these Inferior phrenic arteries were arising from the Coeliac trunk, and in one (2.03%) case Superior suprarenal artery was arising directly from Coeliac trunk and which had even replaced the Middle Suprarenal Artery. None of the Middle and Inferior Suprarenal Artery came from coeliac trunk.Conclusions: Knowledge of Superior Suprarenal Arterial variations while doing surgeries, and during radiological interventions in and around the lesser sac, and involving the Coeliac trunk helps the clinicians in reducing the morbidity and mortality.

Hansen's Disease“ Clinically Atypical Presentation with Atypical Histopathology

Type II Lepra reaction is a Th2 mediated hypersensitivity reaction characterized by involvement of skin and nerves. Herein we report an unusual leprosy case that had a rheumatic mode of onset of Type II Lepra reaction. This case also had livedoid plaques, ulcers on the genitalia, extremities as the initial manifestation of Hansen's Disease and atypical histopathology. His symptoms had started 1 year back as polyarthralgia of both knees and small joints of hands and feet for which he was on immunosuppressant by a Rheumatologist who made a diagnosis of rheumatoid arthritis. After 6 months, patient developed red painful lesions; initially on arms, chest and trunk followed by legs. Subsequently, painful ulcerations developed on feet, knees and genitalia and a dermatology referral was made. Histopathology and slit skin smears led to diagnosis of Lepromatous leprosy in Type II Lepra reaction. Hansen's disease is a great imitator. Rheumatic manifestations can be the initial presentation of Type II Lepra reaction. Rheumatic manifestations thus can be the initial presentation of Type II Lepra reaction even before starting Multi drug therapy. High index of suspicion and routine slit skin smears in small peripheral settings can be helpful in diagnosing and treating such cases.