Unilateral left four renal arteries: case report using MDCT angiography.

We report a very rare case of a 57-year-old male who presented four left renal arteries (RAs) [one main RA and three additional renal arteries (AdRAs)] highlighted incidentally on multidetector computed tomography (MDCT) angiography, which was used to investigate the vascular system of the lower limbs. The distance between the extreme points of RAs origin (upper and lower points of origin) from abdominal aorta (AA) was in the left part of 9.83 cm. The distance between the extreme points of penetration (upper and lower points of penetration) into the left renal parenchyma was 5.23 cm. At the level of origin, the main left RA has an endoluminal diameter of 0.63 cm, much larger in comparison to the other additional left RAs (0.43 cm, 0.33 cm and 0.28 cm, respectively). The length of the main left RA was 2.16 cm, significantly shorter in comparison with the other additional left RAs (2.21 cm, 4.26 cm and 4.73 cm, respectively). The second left RA was the main RA; the first left RA was AdRA (polar superior RA); the third left RA was AdRA (hilar RA); the fourth RA was AdRA (polar inferior RA). Knowledge of this anatomical variation should be considered in planning and performing renal vessel surgery, and kidney transplantation.

An anomalous origin of the gastrosplenic trunk and common hepatic artery arising independently from the abdominal aorta: a case report using MDCT angiography.

The authors describe a case of a 61-year-old female patient, which presented on multidetector computed tomographic (MDCT) angiography a gastrosplenic trunk (GST) and common hepatic artery (CHA) arose independently from abdominal aorta (AA). The GST arose from the anterior wall of the AA, at the level of upper edge of the L1 vertebral body. The left gastric artery (LGA) arose from the superior wall of the GST. The splenic artery (SA) continuous the path of GST. The CHA arose from the anterior wall of the AA, at the level of upper one third of the L1 vertebral body, at 15.3 mm above the origin of superior mesenteric artery (SMA). The incidence and developmental and clinical significance of this vascular variation is discussed with a detailed review of the literature.

Multiple congenital anomalies of carotid and vertebral arteries in a patient with an ischemic stroke in the vertebrobasilar territory. Case report and review of the literature.

The congenital anomalies of the supra-aortic arteries and their branches as potential risk factors for cerebrovascular insufficiency are not yet fully investigated and clarified. This report describes the case of a 68-year-old man who was admitted in our Clinic for an acute ischemic stroke in the vertebrobasilar territory. Extracranial color-coded duplex sonography (CCDS) and computed tomography angiography revealed a combination of congenital anomalies of the neck arteries: left internal carotid artery hypoplasia, left common carotid artery hypoplasia, right vertebral artery hypoplasia and the emergence of the left vertebral artery directly from the aortic arch. The aim of this article is to emphasize the value of CCDS as an accurate, non-invasive method of assessing the neck arteries and, also, the importance of the morphological anomalies of the carotid and vertebral arteries in the cerebral hemodynamics.

Fusiform aneurysm of a persistent primitive trigeminal artery associated with cerebrovascular anatomic variations: a report of two cases.

There are four embryonic anastomoses that exist between the internal carotid artery (ICA) and the vertebrobasilar (VB) system, which may fail to regress postfetal life; one of which is the trigeminal artery. Other persistent anastomoses include those formed by the hypoglossal, otic and proatlantic intersegmental arteries. In addition, other cerebrovascular variations may accompany a persistent primitive trigeminal artery (PPTA); such as arteriovenous malformations, aneurysms, carotid-cavernous fistulas and stenotic cerebral vessels. We present two very rare cases of a left PPTA. In the first case, there was a past medical history significant for cervico-thoraco-lumbar spondylitis and in the second case of an operated occipital astrocytoma. In both cases, the PPTA was associated with a fusiform aneurysm located in the carotidian (lateral) aspect of the PPTA as well as other cerebrovascular anatomic variations. In the first case, the length of the PPTA was 26.0 mm and its endoluminal diameter, at its origin at the ICA, was 1.8 mm; the aneurysm has a length of 8.4 mm. In the second case, the length of the PPTA was 31.0 mm and its endoluminal diameter at its origin at the ICA was 3.0 mm; the aneurysm have a length of 7.6 mm. Identification of these variant vessels should not be ignored before planning and execution of neurosurgeries to prevent possible perioperative risks.

Congenital solitary kidney with multiple renal arteries: case report using MDCT angiography.

A congenital solitary kidney with multiple renal arteries is a rare congenital abnormality that can occur in the presence of multiple other anomalies. We describe an atypical case of a right congenital solitary kidney with three renal arteries (RA) one main RA and two additional renal arteries in a 75-year-old woman with uterine didelphys. The main RA had an intraluminal diameter larger than the diameter of the additional renal arteries (AdRAs) at the origin (0.53 cm for the main RA; 0.49 cm and 0.32 cm for the two AdRAs). Both the AdRAs had a greater length than the main RA (3.51 cm for the main RA; 3.70 cm and 4.77 cm for the two AdRAs). The calculated volume of the kidney was 283 cm³, while the volume of the renal parenchyma was 258 cm³. Knowledge of this variant is extremely important in clinical practice as it has been found to be associated with proteinuria, hypertension and renal insufficiency.

Fenestration of the middle cerebral artery in a patient who presented with transient ischemic attack.

Cerebral artery fenestrations are usually detected incidentally during angiography, have a reported incidence ranging from of 0.03% to 1%, and rarely cause neurological symptoms. They can, however, be associated with aneurysmal dilatation at the proximal or distal end of the fenestration, cerebral arteriovenous malformations, or (rarely) ischemic symptoms. We present a case of a 54-year-old obese woman who presented with a large convex-lens-like fenestration of the right middle cerebral artery (MCA) at the M1 segment (distal to the origin of the temporopolar artery) associated with a transient ischemic attack. The MCA fenestration caused a local change in hemodynamic blood flow, which leads to cerebral ischemia. Magnetic resonance angiography (MRA) also revealed an associated small slit-like fenestration of the basilar artery (BA), hypoplasia of the A1 segment of the right anterior cerebral artery, bilateral fetal posterior cerebral arteries, and bilateral absence of the posterior communicating arteries. To our knowledge, this is the sixth reported case of MCA fenestration with an associated ischemic attack. In our case, fenestrations of the MCA, the BA, and hypoplasia of the A1 segment of ACA were not associated with any aneurysms.

Single ectopic thoracic renal artery associated with a normal kidney position and renal artery stenosis: a case report and review of literature.

There are several reports of multiple ectopic renal arteries (RA) in the literature. However, the ectopic origin of a single RA with a normal kidney position is rare. Knowledge of this variant is extremely important in clinical, surgical and radiological practice. Using MDCT angiography examination, we describe a rare case of a right kidney located in a normal lumbal position with a single ectopic thoracic renal artery originating in the thorax, above the diaphragmatic dome, at the level of the upper one-third of the T12 vertebral body. With an "S"-shaped course and a total length of 103 mm, this artery had an intratoracic portion of 38 mm. It crossed the diaphragm at 23 mm lateral to the right side of the TA, through a hiatus located on the lateral side of the right crus of the diaphragm. The right inferior phrenic artery arose from the left lateral wall of the right RA, 5 mm below the level of CT (45 mm distal to the right RA origin). Remarkably, this variant was associated with an area of proximal arterial stenosis, which produced signs and symptoms of hypertension secondary to renal arterial stenosis. To the authors' knowledge, this is the first reported case of a stenotic single ectopic thoracic renal artery associated with a normal kidney position.

Duplication of the distal end of the left vertebral artery with fenestration of the right posterior cerebral artery.

The vertebrobasilar system (VBS) consists in the intracranial parts of the vertebral arteries (VAs), the basilar artery (BA) and its branches. The presence of a duplication at the level of the intracranial segment of VA (V4) is generally an incidental finding, but may be associated with aneurysms or arteriovenous malformations. We present an extremely rare case of duplication of the distal end of the left vertebral artery, associated with fenestration of the right posterior cerebral artery. The distal end of the left VA was duplicated into two arms (the right with a length of 5.5 mm and a diameter of 2.3 mm that connected with the contralateral VA; and the left with a length of 11.0 mm and a diameter of 1.6 mm, which connected more distally with the BA). The right posterior cerebral artery (PCA) had a fenestration in the posterior segment of the posterior communicating part (P2), with a length of 6.8 mm.

Bilateral triple renal arteries.

We report an atypical case of a 53-year-old male with the presence of six renal arteries (RAs) (bilateral triple) found incidentally on multi-detector computed tomography (MDCT) angiography, which was used to investigate peripheral vascular disease of the lower limbs. The distance between the extreme points of RAs origin from abdominal aorta (AA) was in right 4.42 cm, and in left 2.40 cm. The distance between the extreme points of penetration into the renal parenchyma was in right 2.01 cm, and in left 2.56 cm. On each side, the endoluminal diameter at the origin of the main RA (in right 0.54 cm, and in left 0.42 cm) was significantly larger in comparison with the other additional renal arteries (AdRAs) (in right 0.21-0.29 cm, in left 0.24-0.35 cm); however, the AdRAs were much longer (in right 7.42-10.82 cm, in left 5.90-6.85 cm) than the main RA (in right 6.21 cm, in left 5.73 cm). All the four AdRAs were hilar RAs. Knowledge of this anatomical variation should not be ignoring when planning the adequate interventional radiological and surgical procedure.

Seven renal arteries: a case report using MDCT angiography.

We report an atypical case of a 63-year-old male with the presence of seven renal arteries (RAs) (three right and four left) found incidentally on multi-detector computed tomography (MDCT) angiography which was used to investigate peripheral vascular disease of the lower limbs. Each arterial lumen was analyzed for the diameter at its origin; length and trajectory in the frontal plane (ascendant + or descendant -); and the distance between the point of origin from the abdominal aorta (AA) to its renal intraparenchymal penetration point. We also analyzed the distance between the extreme points of origin of the right and left RAs from the AA and the distance between the extreme points of penetration into the renal parenchyma of the right and left RAs. On each side, the endoluminal diameter at the origin of the main RA was significantly larger than that of the other AdRAs; however, the AdRAs were much longer than that of the main RA. From the six AdRAs, four were hilar RAs and two were superior polar RAs. Knowledge of such cases is of great clinical significance, as it may be beneficial in various urological operations or invasive arterial procedures.

Left crossed fused renal ectopia L-shaped kidney type, with double nutcracker syndrome (anterior and posterior).

Crossed fused renal ectopia (CFRE) is the second most common fusion anomalies (FAs) of the kidneys after horseshoe kidney. Crossed fused renal ectopia (CFRE) results from one kidney crossing over to the opposite side and subsequent fusion of the parenchyma of the two kidneys. We report, by multidetector-row computed tomography (MDCT) angiography, an extremely rare case of a left CFRE (L-shaped kidney type), consisting of multiple renal arteries (one main renal artery for the upper renal parenchyma, and three renal arteries (one main and two additional) for the lower renal parenchyma) and two left renal veins, which produced a double nutcracker syndrome (both anterior and posterior). The L-shaped left kidney has a maximum length of 18.5 cm, a maximum width of 10.2 cm, and a maximum thickness of 5.3 cm. The upper pole of the kidney is located at the level of the lower third of T12 vertebral body (4.6 cm left to the mediosagittal plan); the lower pole is located along the lower half of the L5 vertebral body (1.5 cm left to the mediosagittal plan). The following case will focus on the relevant anatomy, embryology, and the clinical significance of this entity.

Anomalous pattern of origin of the left gastric, splenic, and common hepatic arteries arising independently from the abdominal aorta.

The celiac trunk is the first unpaired midline branch of the abdominal aorta that usually gives rise to the left gastric artery (LGA), the common hepatic artery (CHA) and the splenic artery (SpA). Despite this classic arrangement, many variations exist. We describe an atypical case of an absent CT and anomalous origin of the LGA, CHA and the SpA from the abdominal aorta using multidetector computed tomography angiography (MDCTA) in a 72-year-old male patient. The LGA arose from the anterior wall of the AA at the level of the T12-L1 intervertebral disk [33.8 mm above the origin of the superior mesenteric artery (SMA)]. The SpA originated directly from the anterolateral wall of the AA at the junction of the upper-third and middle-third of the L1 vertebral body (24.8 mm above the origin of the SMA). The CHA branched directly from the anterior wall of the AA at the level of the middle-third of the L1 vertebral body (17 mm above the origin of the SMA). The 64-slice MDCTA system has become the primary tool for evaluation of abdominal blood vessels. It is important to be aware of such a variation as it can have a significant impact on surgical and clinical practice.