Identification and quantitative analysis of branching networks of the posterior intercostal arteries.

Morphological and anatomical characteristics of the posterior intercostal arteries have revived interest in their branching networks. Collateral supply between intercostal spaces is extensive due to anastomoses, although the data about the quantitative description of the branching networks in the existing literature are rather limited. The presence of collateral network between branches of the posterior intercostal arteries has been studied on forty-three Thiel-embalmed human cadavers. A network-based approach has been used to quantify the measured vascular branching patterns. Connections between branches of the same or adjacent posterior intercostal artery were identified. The non-anastomosing branches coursing in the intercostal spaces were also observed and their abundance was higher in comparison to anastomosing vessels. A quantitative analysis of collateral branching networks has revealed the highest density of vessels located close to the costal angle and most of the anastomosing branches were found between the fourth and tenth intercostal space. Anastomoses within the same posterior intercostal artery were more frequent in higher intercostal spaces, whereas in the lower intercostal spaces more connections were established between neighboring intercostal arteries. Our results indicate that due to abundant collateral contribution the possibility to cause an ischemic injury is rather low unless there is considerable damage to the blood supply of the trunk or surgical complication leading to ischemia or necrosis. Analyzing the proper course of collateral contributions of the posterior intercostal arteries may support further directions regarding the safest place for percutaneous transthoracic interventions, thoracocentesis, and lung biopsy.

Noninvasive and real-time pharmacokinetics imaging of polymeric nanoagents in the thoracoepigastric vein networks of living mice.

Noninvasive and real-time visualization of the thoracoepigastric veins (TVs) of living mice was demonstrated by using two-photon excitation (TPE) optical imaging with a Eu-luminescent polymeric nanoagent as the angiographic contrast. The spatiotemporal evolution of the polymeric nanoagent in TVs was monitored for up to 2 h by TPE time-resolved (TPE-TR) bioimaging, which is free from the interference of tissue autofluorescence. A wide field-of-view covering the thoracoabdominal region allowed the visualization of the entire TV network with an imaging depth of 1 to 2 mm and a lateral resolution of 80 µm at submillimeter. Detailed analysis of the uptake, transport, and clearance processes of the polymeric nanoagent revealed a clearance time constant of ∼30 min and an apparent clearance efficiency of 80% to 90% for the nanoagent in both axial and lateral TVs. TPE-TR imaging of the dissected internal organs proved that the liver is mainly responsible for the sequestration of the nanoagent, which is consistent with the apparent retention efficiency of liver, ∼32 % , as determined by the real-time in vivo TV imaging. We demonstrate the potency of TPE-TR modality in the pharmacokinetics imaging of the peripheral vascular systems of animal models, which can be beneficial for related nanotheranostics study.

Gross anatomy of the heart of the alpaca (Vicugna pacos, Linnaeus 1758).

The available information about anatomical characteristics of the cardiovascular system of the alpaca (Vicugna pacos, Linnaeus 1758) is scarce. The general objective of this work was to describe its heart anatomy. We dissected six adult animals and five neonates. The heart of the alpaca was located in the middle mediastinum, with a craniocaudal extension from the third to the sixth rib. No ligament that connected the fibrous pericardium to the sternum or to the diaphragm was detected. In the right atrium, there was a developed crista terminalis and small pectinate muscles. In the right ventricle, the septomarginal trabecula was very large. From the proximities of the interventricular septum arose small septomarginal trabeculae that ended in carnous trabeculae of the septal wall. The left atrium included little developed pectinate muscles. On the left ventricle, both papillary muscles were bilobed. Two left septomarginal trabeculas were detected in this ventricle. The left subclavian artery was originated from the aortic arch separately from the brachiocephalic trunk, and bicarotid trunk was present. The other branches of the subclavian artery were similar to the domestic ruminants. The arterial supply of the heart was of the right type. In conclusion, the heart anatomy of alpaca and the irrigation of thoracic cavity were more similar to those of old world camels and different from domestic ruminants.

Imaging of vascular pseudoaneurysms in the thorax and abdomen.

INTRODUCTION: This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options. OBJECTIVE: The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population. CONCLUSION: In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.

Giant intercostal aneurysm complicated by Stanford type B acute aortic dissection in patients with type 1 neurofibromatosis.

Vascular involvement is rare in neurofibromatosis type 1 (NF1). It is often missed because it is usually asymptomatic. We report a case of a 42 years old male with neurofibromatosis type 1 who presented with left back discomfort. CT angiography revealed a massive 42 mm aneurysm of left 11th intercostal artery. After a discussion between radiologists and cardiothoracic surgeons, endovascular coil embolization was chosen to treat this patient. Percutaneous aneurysm embolization was successfully performed. However, the procedure was complicated by Stanford type B acute aortic dissection. Stanford type B acute aortic dissection was medically managed and patient remained well after discharge. Fragile vascular nature was thought to be one of the causes of this unreported complication.

[Thoracic vascular disease in oncologic patients]. / Patología vascular torácica en pacientes oncológicos.

Patients with oncologic disease require frequent imaging tests (predominantly computed tomography) for follow-up. These patients may have thoracic vascular disease that can influence the diagnosis, treatment, and prognosis of their cancer. Primary vascular tumors can involve the thoracic vessels, like the pulmonary arteries (pulmonary artery sarcoma), and the neoplastic disease can extend locally (lung tumor) or remotely to the thoracic vessels (pulmonary tumor embolism and pulmonary tumor thrombotic microangiopathy). Oncologic treatment results in multiple complications that involve the thoracic vessels and can even compromise the patient's life in certain cases. CT, and especially multislice CT, makes it possible to evaluate neoplastic disease and associated thoracic vascular disease in oncologic patients.

Ultrasonographic assessment of arterial cross-sectional area in the thoracic outlet on postural maneuvers measured with power Doppler ultrasonography in both asymptomatic and symptomatic populations.

OBJECTIVE: The purpose of this study was to evaluate the feasibility and potential usefulness of power Doppler ultrasonography (PDU) in the assessment of changes in arterial cross-sectional area in the thoracic outlet during upper limb elevation. METHODS: Forty-four volunteers and 28 patients with a clinical diagnosis of arterial thoracic outlet syndrome were evaluated by B-mode imaging and PDU. Arterial cross-sectional area was assessed in the 3 compartments of the thoracic outlet with the arm alongside the body and at 90 degrees, 130 degrees, and 170 degrees of abduction. The percentage of arterial stenosis was calculated for each of these arm positions. Nineteen of the 28 patients were also assessed by magnetic resonance (MR) imaging. RESULTS: No significant arterial stenosis was shown in the interscalene triangle and in the retropectoralis minor space of the volunteers and patients. A significant difference (P < .01) in stenosis between volunteers and patients was seen for all degrees of abduction in the costoclavicular space. The 130 degrees hyperabduction maneuver appeared to be the most discriminating postural maneuver. Seven patients assessed with MR imaging did not have any arterial stenosis on MR images, whereas an appreciable degree of arterial stenosis was shown with ultrasonography. CONCLUSIONS: Arterial compression inside the thoracic outlet can be detected and quantified with B-mode imaging in association with PDU.

Relation of postural vasovagal syncope to splanchnic hypervolemia in adolescents.

BACKGROUND: The mechanisms of simple faint remain elusive. We propose that postural fainting is related to excessive thoracic hypovolemia and splanchnic hypervolemia during orthostasis compared with healthy subjects. METHODS AND RESULTS: We studied 34 patients 12 to 22 years old referred for multiple episodes of postural faint and 11 healthy subjects. Subjects were studied in the supine position and during upright tilt to 70 degrees for 30 minutes and subgrouped into S+, historical fainters who fainted during testing (n=24); S-, historical fainters who did not faint during testing (n=10); and control subjects. Supine venous occlusion plethysmography showed no differences between blood flows of the forearm and calf in S+, S-, or control. Cardiac index, total peripheral resistance, and blood volume were not different. Using impedance plethysmography, we assessed blood redistribution during upright tilt. This demonstrated decreased thoracic blood volume and increased splanchnic, pelvic, and leg blood volumes for all subjects. However, thoracic blood volume was decreased in S+ compared with control volume, correlating well with the maximum upright heart rate. Splanchnic volume was decreased in the S+ and S- groups, correlating with the change in thoracic blood volume. Pelvic and leg volume changes were similar for all groups and uncorrelated to thoracic blood volume. CONCLUSIONS: Enhanced postural thoracic hypovolemia and splanchnic hypervolemia are associated with postural simple faint.

Thoracoscopy: a new era for surgical anatomy.

In this new era of minimal access surgery, advances in optics and illumination have established thoracoscopic sympathectomy as a pre-eminent procedure, including a safe and efficient technique for upper limb sympathectomy. The success of thoracoscopy will doubtless ensure that a greater number of these procedures will be carried out and will put some of the daunting technical challenges posed by traditional open surgical procedures to rest. The thoracoscopic era affords the surgical anatomist a new challenge: to move the teaching of living anatomy to a higher level.