A left circumflex aorta with a displaced thoracic duct in a 94-year-old male cadaver: a case report with discussion on embryology

A left circumflex aorta (LCA) is an extremely rare variation of the thoracic aorta. It is distinguished by a retroesophageal descending aorta that subsequently travels down the right side of the thoracic vertebrae towards the aortic hiatus. Nonetheless, its embryological origin ought not to be overly generalized, but each case should be considered individually due to its unique vascular patterns. This study presents a description of a LCA in a 94-year-old male cadaver. The dissection revealed the descending aorta posteriorly from the trachea and esophagus and then laterally on the right from the thoracic vertebral bodies. The branching pattern of the aortic arch was typical, so was the course of the left and right recurrent laryngeal nerves. However, the thoracic duct was placed on the right, and drained into the right internal carotid vein. Due to the normal appearance of the ascending part and the arch of the aorta, it is safe to presume that the variation originated from the persistent right dorsal aorta, with the retroesophageal part from the persistent left dorsal aorta. Detailed understanding of the variations of the thoracic aorta, and the anomalies associated with the LCA, can help to improve management of these conditions, and with that, improve patients’ overall outcomes. Patients with a LCA, or another vascular ring, can either be asymptomatic or present with esophageal and / or tracheal compression symptoms. Management of this anomaly consists namely of ligation of the patent ductus arteriosus / ligamentum arteriosum and aortic uncrossing

Extensor digitorum muscle tendon to the index finger from the extensor carpi radialis brevis: a cadaveric case report

The forearm extensor compartment is known for its wide variability in terms of muscle origin, number of tendons and their distal insertion. The index finger on its dorsal aspect is the typical place of insertion of the two tendons of the extensor digitorum (ED-index) and of the extensor indicis. Being acquainted with their anatomy is of immense importance to orthopedic surgeons in the treatment of e.g., de Quervain’s syndrome. The current report presents a rare finding of the ED-index tendon arising from the extensor carpi radialis brevis (ECRB). A routine dissection revealed their fused course from the lateral epicondyle of humerus, though separate from the extensor carpi radialis longus. The ED-index muscle belly separated from the ECRB, 119 mm distal to the lateral epicondyle. The distal insertion point of the ED-index was located radially to that of the extensor indicis. The deep branch of the radial nerve and the recurrent interosseous artery supplied the ED-index. No other musculotendinous variations were encountered neither on the ipsilateral nor the contralateral upper limb of the cadaver. This study presents in detail a tendon of the ED-index arising from the ECRB, a knowledge that can be applied namely in the lateral epicondylitis treatment or approach to the ulnar nerve at the level of the elbow. Extensive depiction of both the proximal and distal attachment points of the muscles, their course and dimensions is indispensable to attain the best patient outcomes and avoid iatrogenic injuries

Agenesis of the sphenoid sinus and a single sphenoid sinus: a computed tomography anatomical evaluation

Background: Sphenoid sinuses are pneumatic spaces within the body of the sphenoid bone. Their development begins in the prenatal life and continues until the adulthood. Agenesis of the sphenoid sinuses is a situation in which they are undeveloped. On the other hand, a single sphenoid sinus lacks the presence of the main septum, leading to the formation of a single antrum. Contemporary use of transnasal transsphenoidal approaches for the pituitary surgery, as well as functional endoscopic sinus surgery urges medical professionals to be well acquainted with the aforementioned variant.Materials and methods: Paranasal sinuses of 300 patients (150 females, 150 males) were evaluated using computed tomography, without the use of contrast medium. Inclusion criteria involved absence of any identifiable pathology within the sphenoid sinuses and age over 18 years. Subgroup analysis involved probing for potential sources of heterogeneity, namely gender.Results: In the whole research material of 300 patients, agenesis of the sphenoid sinuses was noted in 1% of the patients. No statistically significant differences were noted between the absence of the sphenoid sinuses and gender (p = 0.999). A single sphenoid sinus was found in 0.33% of the patients. There were no statistically significant differences found between the presence of fully developed sphenoid sinuses and gender (p = 0.498).Conclusions: Both agenesis of the sphenoid sinuses and a single sphenoid sinus are rare anatomical variants. Adequate planning for transsphenoidal surgeries with preoperative medical imaging is of essence in order to perform a safe and quality procedure