Unusual Branching Pattern of Axillary and Brachial Arteries in the Right Upper Limb – A Case Report

Variations of the vascular pattern of proximal part of the upper arm are very common. Knowledge of anomalies in the origin and course of principal arteries is important for the vascular radiologists and surgeons. Several variations of the axillary artery, brachial artery and theirs branches have been reported. We found a common trunk (about 3cm long) of lateral thoracic and subscapular arteries from the axillary artery and a common trunk (about 4cm long) of posterior circumflex humeral and profunda brachii arteries from brachial artery. The profunda brachii artery ran downwards along with radial nerve and entered the radial groove. The posterior circumflex humeral artery hooked around the aponeurosis of latissimus dorsi muscle and supplied its usual area around the glenohumeral joint.

Short Axillary Vein and an Axillary Venous Ladder Formed by Basilic and Brachial Veins – An Anatomical and Clinical Perspective

Knowledge of anatomic variants of veins in the arm and axilla play a key role in planning of successful venous access. Possible anatomic variants of axillary vein, brachial vein and basilic vein and their clinical implications have been well described in the literature. We report a rare case of formation of a short axillary vein associated with complex venous communications between the basilic and brachial veins forming a venous ladder in the axilla, in formalin embalmed male cadaver. Axillary vein was formed in the upper part of the axilla by the fusion of basilic vein and unpaired brachial vein, and it was about 3cm in length. The higher-up confluence of basilic and brachial veins was also associated with presence of three communicating veins between the basilic and brachial veins in the axilla. Knowledge of reported venous variations is very useful during preoperative venous mapping and also for planning and execution of various surgical invasive procedures involving these veins.

An Unusual Venous Plexus on Psoas Major Muscle Connecting the Inferior Mesenteric and Testicular Veins

Knowledge of communication between parietal abdominal veins, testicular vein and mesenteric veins is important for Surgeons, Urologists and Radiologists. These communications can result in varicocele or hemorrhoids and may lead to low success rate in hemorrhoid and varicocele surgeries. During routine dissection classes, we observed an unusual large venous plexus on the left psoas major muscle. The venous plexus was unilateral and was formed by many anastomotic venous channels on the psoas fascia and communicated with the left testicular and inferior mesenteric veins. The testicular and inferior mesenteric veins were significantly enlarged below the level of communication with the venous plexus.

Unusual Path of Branches of Ilioinguinal Nerve: A Clinically Important Anatomic Variant

Ilioinguinal nerve is a collateral branch of lumbar plexus. Its anatomical variations in relation to adjacent musculoaponeurotic structures play a crucial role in the development of neuropathies associated with lower abdominal surgeries. In this report, we present a rare case of unusual course and branches of the ilioinguinal nerve, in a 55-year-old male cadaver. In the lateral part of inguinal canal ilioinguinal nerve gave three branches. Two of its branches pierced the external oblique aponeurosis, about 6 cm above the pubic symphysis, to supply the skin of the lower part of the anterior abdominal wall. Another branch pierced the conjoint tendon, in the medial part of the inguinal canal about 2 cm above the superficial inguinal ring. Knowledge of unusual path of these branches may be important to avoid injuries during the surgical repair of groin hernias. Further care should be taken while dealing with the conjoint tendon in the Bassini procedure.

Variant Origin of the Left Vertebral Artery from a Vertebro-Subclavian Trunk Associated with an Unusual Branch Arising from the Brachiocephalic Trunk

Variant origin of the left vertebral artery (LVA) from the arch of aorta is well documented in the literature. Involvement of complex sequential developmental steps in the aortic arch formation results in different patterns of origin of LVA. Morphological variations in the LVA are thought to alter the cerebral hemodynamics and can cause the cerebral dysfunction. Knowledge of the morphological variations of the LVA is useful while performing the head and neck and thoracic surgeries. We here report one of the extremely rare patterns of the LVA origin, in a male cadaver aged about 65 years. LVA and left subclavian artery (LSA) arose as a common vertebro-subclavian trunk from the convexity of the aortic arch. Further, brachiocephalic trunk (BT) gave an unusual artery from its anterior surface. This artery divided into thymic and tracheal branches. Variant origin of thymic branch may be crucial during imaging and thymectomy procedures.

Uncommon Peritoneal Anomaly of Spleen Associated with the Unusual Relationship of Spleen with the Left Lobe of the Liver

Though congenital anomalies of the spleen are quite common, the peritoneal anomalies of the spleen are very rare. In the present case, we observed two unusual phrenico-splenic ligaments connecting the spleen to the diaphragm. Apart from this, the left lobe of the liver was elongated and was related to the diaphragmatic surface of the spleen. The splenic artery had a straight course to the spleen, indicating the possible restricted movements of the spleen. Knowledge of such unusual relation of spleen is essentially important for the surgeons as the elongated left lobe of the liver might get ruptured in addition to the spleen in the fractures of the left 9th, 10th and 11th ribs. Awareness of the straight course of the splenic artery is also of importance to Radiologists performing arterial splenoportography.

Replaced Right Hepatic Artery Associated with Uncommon Triplet Right Renal Vein: Embryological Perspective and Clinical Importance 45

Vascular variations in the abdomen are common and mostly asymptomatic. Knowledge of these variations are of tremendous clinical importance in patients undergoing invasive endovascular interventions such as liver transplantation, renal transplantation, and vascular reconstruction for congenital and acquired lesions and trans-arterial chemoembolization for the hepatic tumors. During regular dissection classes for the medical undergraduates, we encountered concurrent vascular variations in an elderly male cadaver. In the present case, we report multiple vascular anomalies involving the right hepatic artery and the right renal vein. The right hepatic artery branched off from superior mesenteric artery, and it was identified as a replaced right hepatic artery. The right kidney was drained by three renal veins, the uppermost among the three twisted around the superior branch of the right renal artery before terminating into the inferior vena cava. In addition, the left kidney was supplied by two renal arteries, and drained by a single renal vein.