A previously undescribed case of the axillary arch muscle

The axillary arch muscle, also called Langer’s muscle, axillopectoralis, or pectodorsalis is a muscular variation of the latissimus dorsi muscle. During a standard anatomical dissection, the axillary arch muscle was found bilaterally. On both sides it originated from the latissimus dorsi as a muscle belly. Next it was passing into wide tendinous structure attached to the tendon of the pectoralis major muscle. Then, the narrow tendinous slip inserted into the coracoid process was found. The axillary arch muscle was innervated by the thoracodorsal nerve on both sides. Knowledge about morphological variations in this region is important since there is a direct relationship with neurovascular structures, e.g., ending branches of the brachial plexus, which may lead to paresthesia or muscle weakness

Coexistence of rare varieties of palmaris profundus and flexor superficialis muscle

The superficial layer of the anterior compartment of the forearm is characterized by different morphological variations. During standard anatomical dissection, two morphological variations in the superficial compartment of the forearm were observed. The first one was the palmaris profundus, which originated from the radius and distally fused with the tendon to 3rd digit (from the flexor digitorum superficialis muscle) inserted on the medial phalanx of the third digit. The second variation was a distinct superficial flexor of the 4th digit represented by one muscle belly with originated from a common mass from the medial humeral epicondyle, passes through the carpal tunnel, and is inserted into the medial phalanx of the fourth digit. The flexor digitorum superficialis muscle was located deeply to it and it was divided only into three tendons (to 2nd, 3rd, and 5th digits). Tendons connected to the 2nd and 3rd digits were crossed with each other at the level of carpal tunnel. From the humeroulnar head of the flexor digitorum superficialis muscle, an additional muscle belly was arising and its tendon was fused with the superficial flexor of the fourth digit. Knowledge about morphological variations in this region is clinically important because of the direct correlation with the median nerve, and the possibility to cause carpal tunnel syndrome

Unique branching pattern of the internal iliac artery accompanied by an supernumerary internal iliac vein

Understanding the complex vascular anatomy of the lesser pelvis is vital in diagnostics and management of numerous pathologies in gynaecology, urology, orthopaedics and general surgery. The following case reports describes an unusual, undescribed branching pattern of the internal iliac artery with additional specific branches, as well as an unprecedented supernumerary internal iliac vein. Both clinical significance and embryology of the case are discussed

Two-headed extensor digitorum longus with coexisting additional tendinous slips

The extensor digitorum longus is a source of much anatomic variation, mostly related with extra tendinous slips or their unusual insertions. This report describes a new configuration of the extensor digitorum longus with two heads and two main tendons which bifurcate into five slips. These slips undergo further divisions and establish connections between the each other. Our findings provide a greater insight into the intricacies of human morphology

Two variant muscles in the gluteal region

The short lateral rotators of the thigh found in the gluteal region can have morphological variations. During anatomical dissection of a right lower limb, two variant structures were found in this region. The first of these accessory muscles originated from the external surface of the ramus of the ischium. Distally, it was fused with the gemellus inferior muscle. The second structure comprised tendinous and muscular parts. The proximal part originated from the external part of the ischipubic ramus. It inserted on the trochanteric fossa. Both structures were innervated by small branches of the obturator nerve. The blood supply was via  branches of the inferior gluteal artery. There was also a connection between the quadratus femoris and the superior part of the adductor magnus. These morphological variants could be clinically important

A very rare case report: accessory head of the sartorius muscle

Background: The sartorius muscle belongs to the anterior compartment of the thigh. Morphological variations of this muscle are very rare, few cases being described in the literature. Materials and methods: A 88 year-old female cadaver was dissected routinely for research and teaching purposes Results: However, an interesting variation was found during anatomical dissection. The proximal part of the sartorius muscle had the normal course, but the distal part bifurcated into two muscle bellies. The additional head passed medially to the standard head; thereafter there was a muscular connection between them. This connection then passed into the tendinous distal attachment. It created a pes anserinus superificalis, which was located superficially to the distal attachments of the semitendinosus and gracilis muscles. This superficial layer was very wide and attached to the medial part of the tibial tuberosity and to the crural fascia. Importantly, two cutaneous branches of the saphenous nerve passed between the two heads. The two heads were innervated by separate muscular branches of the femoral nerve. Conclusions: Such morphological variability could be clinically important

A three-headed plantaris muscle fused with Kaplan fibers: potential clinical significance

The plantaris is a short, small muscle that usually originates at the popliteal surface of the femur and has a long, thin tendon that typically inserts into the calcaneal tuberosity. Its role and degree of development have been objects of debate for years. Some authors consider it a vestigial muscle while others believe it is a process of its development. The clinical significance of plantaris muscle is usually related to its morphological variation, which is common and well described in the literature. These variations are often a risk factor for many ailments and disorders. We would like to present another, very rare case of three-headed plantaris muscle (fused with distal Kaplan fibers), and consider what clinical implications it may have

Very rare arrangement of the pes anserinus: potential clinical significance

The pes anserinus superficialis is composed of the semitendinosus, gracilis and sartorius tendons. Normally, they all insert to the medial side of the tibial tuberosity, and the first two are attached superiorly and medially to the tendon of the sartorius muscle. During anatomical dissection, a new pattern of arrangement of tendons creating the pes anserinus was found. The pes anserinus comprised three tendons; the semitendinosus tendon was located superiorly to the gracilis tendon, and they both had distal attachments on the medial side of the tibial tuberosity. This seemed like the normal type, but the tendon of the sartorius muscle created an additional superficial layer, its proximal part lying just below the gracilis tendon and covering the semitendinosus tendon and a small part of the gracilis tendon. After crossing the semitendinosus tendon it is attached to the crural fascia significantly below the tibial tuberosity. Good knowledge of the morphological variations of the pes anserinus superficialis is necessary during surgical procedures in the knee region, especially anterior ligament reconstruction

Morphological variability of the leg muscles: potential traps on ultrasound that await clinicians

Background: Although muscles and their tendons are not considered the most morphologically variable structures, they still manifest a substantial diversity of variants. The aim of this study is to increase awareness of some of the many possible variants found during ultrasound imaging of one lower limb compartment, the leg, that could potentially mislead clinicians and lead to misdiagnosis. Materials and methods: PubMed was used for a comprehensive literature search for morphological variations. Relevant papers were included, and citation tracking was used to identify further publications. Results: Several morphological variants of muscles of the leg have been described over many years, but this study shows that the occurrence of further variations in ultrasound imaging requires further investigations. Conclusions: The incidence of additional structures including muscles and tendons during ultrasound examination can cause confusion and lead to misinterpretation of images, misdiagnosis, and the introduction of unnecessary and inappropriate treatments

Lung segments from anatomy to surgery

Bronchopulmonary segments are of increasing interest to clinicians because surgical procedures are emerging that maintain as much pulmonary function as possible. The conventional textbook borders between these segments, their many anatomical variations, and their numerous lymphatic or blood vessels, make them challenging for surgeons, especially thoracic surgeons. Fortunately, because imaging techniques such as 3D-CT are developing further, we can see the anatomical structure of the lungs in detail. Moreover, segmentectomy is now seen as an alternative to a more radical lobectomy, especially for lung cancer. This review explores the connection between the anatomical structure of the lungs, especially their segments, and surgical procedures. Further research on minimally invasive surgical procedures is timely as we can diagnose lung cancer and other diseases ever earlier. In this article, we will look at the latest trends in thoracic surgery. Importantly, we propose a classification of lung segments in reference to surgery difficulties due to their anatomy