CONSTRUCCIÓN DE LA IGLESIA SOBRE LA ERMITA DE LA LUZ [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 201

Inferior paraumbilical vein.

CT venogram of chest in a 56-year-old woman with SVC obstruction. (A) Slightly oblique 7.5-mm coronal maximum-intensity-projection (MIP) shows an inferior paraumbilical vein (arrowhead) terminating at the umbilical notch of the liver (asterisk). It is predominantly opacified by two tributaries continuous with ensiform vessels (right-left arrow). A third tributary (curved arrow) joins a subcutaneous vein (not shown). The apparent discontinuity in the right ensiform vessel is due to tortuosity. Also shown is the umbilical vein (straight arrow). X, xiphoid process. (B) Oblique transverse 7-mm MIP demonstrates the inferior vein (arrowhead) joining dilated terminal portal vessels in segments IV and III at the margin of the liver. The terminal vessels in segment IV drain into an expanded second- or third-order portal branch that empties into the distal left portal vein (LPVu) resulting in antegrade opacification of an adjacent second- or third-order portal branch (curved arrow) in segment IV and of portal branches in segments III and IV posteriorly. The collateral ensiform veins (straight arrows) are shown in the properitoneal fat pad.</p

Systemic connections of collateral ensiform veins (<i>N = 22 patients</i>).

<p>Systemic connections of collateral ensiform veins (<i>N = 22 patients</i>).</p

Sources of collateral flow to the paraumbilical veins.

<p>Sources of collateral flow to the paraumbilical veins.</p

Visual model of the arrangement and systemic anastomoses of collateral paraumbilical veins.

<p>The potential collateral pathways between the systemic and paraumbilical veins are shown. Only the left epigastric and subcutaneous vessels are included. An inferior vessel (arrowhead) terminates at the umbilical notch and receives tributaries continuous with ensiform veins, and deep epigastric and subcutaneous veins, which cross the rectus sheath or linea alba (not shown). The ensiform veins descend from a transverse branch of the internal thoracic veins at the xiphoid process. The patent part (arrow) of the umbilical vein (UV) also receives an inferior vein with its tributaries. The obliterated umbilical vein joins the umbilicus. The superior veins communicate with diaphragmatic branches of the internal thoracic, anterior mediastinal and pericardiacophrenic veins. (Visual model created by MUHC Patient Education Office).</p

Anatomical depictions of the paraumbilical and ensiform veins.

<p>(A) Detail of Braune’s 1884 color lithograph of the veins of the anterior trunk, Tafel (plate) IV. The muscles were partially removed to uncover the internal thoracic (14) and epigastric veins. The superior (11) and inferior epigastric (2) veins, and their deep tributaries (6) lie superficial to the posterior layer of the rectus sheath. Also exposed are the subaponeurotic obliterated umbilical vein (9) and adjacent inferior Sappey veins (8) ascending from the umbilicus (7) before disappearing in the falciform ligament. A pair of venae paraumbilicalis xyphoidae (10) enter the left superior epigastric vein after piercing the rectus sheath next to the linea alba (a). There are also two unnamed vessels that enter a transverse vein (12) bridging the internal thoracic veins at the xiphoid process. These vessels are likely ensiform veins ascended from the properitoneal fat pad deep to the rectus sheath except at the very top. (Courtesy US National Library of Medicine) (B) Illustration of the properitoneal fat pad and the ensiform branches of the left internal thoracic vessels in a specimen, posterior view. The parietal peritoneum was opened and turned aside, and the xiphoid process was resected. (From Nordenson et al. (1930), by permission of Springer).</p

Inferior and superior paraumbilical veins.

<p>CT venogram of chest and abdomen in a 53-year-old man with SVC obstruction. (A) Oblique sagittal 10-mm maximum-intensity-projection (MIP) through the umbilical fissure shows an inferior paraumbilical channel (white arrowhead) ascending from deep epigastric veins (curved white arrow). It receives an ensiform vein (straight white arrow) and terminates in the left portal vein (LPVu). Note antegrade filling of a second-order portal branch (curved black arrow) and its territory in segment IV. Also shown are tiny superior paraumbilical veins destined for segment III, which form a tiny venous arch (black arrowhead) and are supplied by the ensiform vein. Straight black arrows point to hepatic veins. (B) Slightly oblique transverse 7-mm MIP shows the collateral channel (short white arrow) in the umbilical fissure and the opacification of segment IV. The tiny superior veins (arrowheads) opacify segment III. The long white arrow points to the ensiform vein; black arrows indicate hepatic veins.</p

CT of the paraumbilical and ensiform veins in patients with superior vena cava or left brachiocephalic vein obstruction

<div><p>The purpose of this study was to elaborate on the anastomoses between the paraumbilical and systemic veins, particularly the ensiform veins. The connections with the ensiform veins have received little attention in the anatomical and radiological literature, and remain incompletely described. Too small to be reliably traced in normal CT scans, the paraumbilical veins can dilate in response to increased blood flow from systemic veins in superior vena cava obstruction (SVCO), allowing a study of their arrangement and connections. Collateral paraumbilical veins were therefore analyzed retrospectively in 28 patients with SVCO using CT. We observed inferior and superior groups of collateral vessels in 23/28 (82%) and 17/28 (61%) patients, respectively. Inferior veins ascended towards the liver and drained into portal veins (19/28, 68%) or the umbilical vein (8/28, 29%); superior veins descended and drained into portal veins. The inferior veins (N = 27) could be traced to ensiform veins in almost all of the cases (26/27, 96%), and a little over half (14/27, 52%) were also traceable to subcutaneous and deep epigastric veins. They were opacified by ensiform (25/27, 93%), deep epigastric (4/27, 15%) and subcutaneous (4/27, 15%) veins. The superior veins (N = 17) were supplied by diaphragmatic (13/17, 76%) and ensiform veins (4/17, 24%); the diaphragmatic veins were branches of collateral internal thoracic, left pericardiacophrenic and anterior mediastinal veins. Collateral ensiform veins were observed in 22 patients and anastomosed with internal thoracic (19/22, 86%), superior epigastric (9/22, 41%), diaphragmatic (4/22, 18%), subcutaneous (3/22, 14%) and anterior mediastinal veins (1/22, 5%). These observations show that the paraumbilical veins communicate with ensiform, deep epigastric, subcutaneous and diaphragmatic veins, joining the liver to the properitoneal fat pad, anterior trunk, diaphragm and mediastinum. In SVCO, the most common sources of collateral flow to the paraumbilical veins are the ensiform and diaphragmatic branches of the internal thoracic veins.</p></div

Clinical features of 28 patients with superior vena cava (SVC) or left brachiocephalic vein (LBCV) obstruction and collateral paraumbilical veins.

Clinical features of 28 patients with superior vena cava (SVC) or left brachiocephalic vein (LBCV) obstruction and collateral paraumbilical veins.</p

Distribution of the portal segments opacified by collateral paraumbilical veins.

<p>Distribution of the portal segments opacified by collateral paraumbilical veins.</p