Lateral-bilateral costal branch (R. costalis lateralis): a clinically relevant anatomical variation / Rama costal lateral bilateral (R. costalis lateralis): una variación anatómica clínicamente relevante

SUMMARY: The lateral costal branch (LCB) is a variation present in 15-30 % of the population. This blood vessel runs parallel and laterally to the internal thoracic artery from which it originates. Knowledge about the LCB is relevant for thoracic surgeons. In this study we present the findings from the dissection in a practical teaching exercise of the cadaver of a 62-year-old male. The thoracic contents were accessed by raising the anterolateral thoracic wall, the pulmonary pedicles were dissected and both lungs were removed. We observed bilaterally the trajectory of the LCB at the level of the medial axillary line parallel to the internal thoracic artery. On the right side, the LCB originates from the internal thoracic artery at the level of the first rib and extends to the eighth intercostal space, with a length of 26 cm and a caliber of 1.95 mm, communicating with the anterior and posterior intercostal arteries. The left branch originates from the internal thoracic close to their origin artery and extends until the sixth intercostal space, with a length of 14 cm and a caliber of 1.55 mm. it connects with the anterior and posterior intercostal arteries. On both sides the arteries were accompanied by a pair of satellite veins. The lateral costal arteries form part of the circulation of the thoracic wall, constituting an accessory arterial system with a trajectory parallel to the internal thorax and the aorta. Knowledge of it is relevant for invasive procedures, and myocardial revascularization procedure.

RESUMEN: La rama costal lateral es una variación presente en el 15-30 % de los casos, y sigue paralelo y lateral a la arteria torácica interna, de la cual se origina, siendo su conocimiento relevante para los cirujanos de tórax. Se presenta un hallazgo durante una disección en una actividad práctica docente, en un cadáver de sexo masculino de 62 años. Se accedió al contenido torácico levantando la pared esternocostal, procedimiento que comenzó con disección de la piel y musculatura hasta exponer ambas clavículas, se realizó un corte transversal de éstas en su tercio lateral para posteriormente realizar sección bilateral desde la primera hasta la octava costilla siguiendo la línea axilar anterior. Una vez revertida la pared esternocostal, se seccionaron los pedículos pulmonares, y se retiraron ambos pulmones. Se observó bilateralmente en la pared torácica el trayecto de un paquete vascular a nivel de la línea axilar media paralela a la arteria torácica interna. En el lado derecho se originaba a 2 cm del trayecto de la arteria torácica interna y se extendía hasta el octavo espacio intercostal con una longitud de 26 cm y un calibre de 1,95 mm, estableciendo comunicaciones con las arterias intercostales anteriores y posteriores, agotándose en ellas. La rama izquierda se originaba a 1,5 cm del trayecto iniciado por la arteria torácica interna extendiéndose hasta el sexto espacio intercostal; presentó un calibre de 1,55 mm y una de longitud de 14 cm, estableciendo comunicaciones con las arterias intercostales anteriores y posteriores, agotándose en ellas. En ambos lados las arterias eran acompañadas por un par de venas satélites. Las arterias costales laterales forman parte de la circulación de la pared torácica, constituyendo un sistema arterial accesorio al de la arteria torácica interna y la aorta. Su conocimiento es relevante en procedimientos invasivos, además de tener un alto valor docente y formativo.

Pre-aortic inter-azygos veins: two case reports / Venas interácigos pre-aórticas: reporte de dos casos

This report describes two cases of multiple anomalies associated with the azygos venous system. In Case 1, the hemiazygos vein drained the 9th to 11th left posterior intercostal veins. At T9 vertebral level, the interazygos vein passed obliquely and anterior to the aorta to drain into the azygos vein on the right. In Case 2, the common venous trunk formed by the accessory hemiazygos and hemiazygos veins passed anterior to the aorta to drain into the azygos vein at T9 vertebral level. These findings represent pre-aortic inter-azygos veins, which is a rare variation of the azygos venous system. Pre-aortic inter-azygos veins can mimic pathologies such as enlarged lymph nodes, tumors and aneurysms leading to misinterpretation of radiographs, computerized tomography and magnetic resonance scans. Surgeons need to be aware of this type of variation so as to avoid injury of any anomalous passing venous vessels.

Este informe describe dos casos de múltiples anomalías asociadas con el sistema venoso ácigos. En el caso 1, la vena ácigos drena las 9 y 11 venas intercostales posteriores izquierdas. A nivel de la 9 vértebra torácica, la vena interácigos pasó oblicuamente y anterior a la aorta para drenar en la vena ácigos del lado derecho. En el caso 2, el tronco venoso común formado por las venas hemiácigos accesoria y hemiácigos pasaron anterior a la aorta para drenar en la vena ácigos a nivel de la 9 vértebra torácica. Estos resultados representan venas interácigos pre-aórticas, que es una rara variación del sistema venoso ácigos. Las venas interácigos pre-aórticas pueden imitar patologías, como agrandamiento de nódulos linfáticos, tumores y aneurismas que conducen a una mala interpretación de las exploraciones por radiografías, tomografía computarizada y resonancia magnética. Los cirujanos deben ser conscientes de estos tipos de variaciones para evitar lesionarlos.

Infracardiac total anomalous pulmonary venous drainage with unusual presentation.

Total anomalous pulmonary venous drainage (TAPVD) is a rare entity which forms approximately 0.4 to 2% of all congenital heart disease. The infracardiac type usually involve obstructions on pulmonary venous connections and comprising a quarter of all TAPVD cases. The clinical findings in patients with obstructed infracardiac TAPVD could mimic respiratuary distress of several different etiologies during first hours of life. In this article,we present a case of a neonate with infracardiac type of TAPVD presented with only distinct subcutaneous veins of abdominal and thoracic wall.

Doença de Mondor da mama: relato de um caso / Mondor's disease in breast: case report

A doença de Mondor da mama é um evento pouco frequënte na prática clínica, com cerca de 281 casos na literatura mundial de 1966 a 2002, caracterizando-se por uma tromboflebite de veia superficial da região toracoabdominal de natureza benigna. Pode manifestar-se secundariamente a doenças sistêmicas, a intervenções cirúrgicas ou idiopáticas. Geralmente tem regressão espontânea em poucas semanas. Os autores relatam o caso de uma paciente do sexo feminino, 35 anos, que apresentou-se com dor e cordão fibroso na região toracoabdominal ântero-lateral esquerda havia um mês, sem outros sintomas associados. Ao exame físico apresentava bom estado geral, mamas normais e presença de endurecimento em todo o trajeto da veia torácica lateral esquerda. Com diagnóstico clínico de doença de Mondor, submeteu-se à realização de exames complementares que foram normais. Recebeu antiinflamatórios não-hormonais, com melhora sintomática em duas semanas. A resolução completa do cordão fibroso ocorreu após 18 meses de seguimento.

Mondor's disease of breast is an uncommon benign condition with approximately 281 cases related in world literature from 1966 to 2002, characterized by thoracoabdominal superficial vein thrombophlebitis. It can be secondary to sistemic diseases, surgical procedures, or idiopathic. It is generally a self-limited condition. The authors present a case of a 35-year-old female who complained of pain and a fibrous "string" on the left anterolateral thoracoabdominal region for one month, without correlated symptoms. At a physical examination she presented good health, normal breast and skin induration along left lateral thoracic vein. With clinical diagnosis of Mondor's disease she was submitted to complementary exams which were normal. She received nonsteroidal anti-inflammatory drug with symptomatic relief in two weeks. After 18 months, complete resolution of the fibrous "string" ocurred.