Anatomical study of partial anomalous pulmonary venous return with special references to the bronchial vein: supplementary report

After the authors' previous report an additional case of partial anomalous pulmonary venous return was encountered during dissection practice for medical students. In an 87-year-old Japanese male cadaver, the anomalous vein from the right upper lobe drained into the superior vena cava at a point just below the entrance of the azygos vein. This case is similar to the first case in the authors' previous report, but the anomalous vein was recognized before dissection of the lung began. Therefore, findings were more precisely observed. The anomalous pulmonary vein was 16 mm in diameter and had three branches, which drained the regions of the apex, the anterior segment and a part of the posterior segment of the right upper lobe. The other veins from the right lung gathered into two pulmonary veins, measuring 21 mm and 18 mm in diameter, respectively, and returned to the left atrium as usual. It is noteworthy that the anomalous vein received the bronchial vein from the right upper lobe bronchus. The azygos vein also received the bronchial veins from the lower part of the trachea and from the right middle and lower lobe bronchi. The theory that the bronchial vein plays an important role in the occurrence of the anomalous pulmonary drainage is further supported by this finding.     

A case of persistent left superior vena cava with a horseshoe kidney]

A case of persistent left superior vena cava with a horseshoe kidney was found in a Japanese male cadaver (72 years old) during a dissection for students in 1989. The main findings were as follows. The right superior vena cava (21.2 mm average diameter) was normal and opened into the right atrium. The left superior vena cava (8.4 mm average diameter) was smaller than the right one and ran in the coronary sinus to reach the right atrium. There was a small transverse anastomosis (8.9 mm average diameter), which corresponded to the normal left brachiocephalic vein, between the right and left superior vena cava. The azygos vein system showed a symmetrical condition and the right and left azygos veins opened into the superior vena cava on each side. This was the 57th case of persistent left superior vena cava reported in the anatomical literature in Japan. It corresponded to Type 3 of the classification by Fujimoto et al. (1971), and might be the first report of Type 3 in Japan. The horseshoe kidney was a typical one, in which the right and left kidneys were fused by an isthmus (bridge) consisting of renal tissues at their lower poles. The positions of both kidneys were lower than those of normal ones, the bilateral renal hili opened ventrally, the ureters ran on the anterior surface of the isthmus, the longitudinal axes of both kidneys crossed each other under the isthmus, and there were some additional renal arteries and veins. Neither the persistent left superior vena cava nor the horseshoe kidney alone are very rare anomalies, but a case such as the present, in which both anomalies coexist in the same body, is very rare.     

Anomalous venous system in the human heart

In a 2002 cadaveric dissection course, a complex manner of rare variation was found in the abnormal venous system of the heart of an 88-year-old Japanese man who died of acute pneumonia. The superior vena cava and the left and right brachiocephalic veins were normal. In this case, a complex venous system existed as follows. (1) A left superior vena cava was persistent. (2) The innominate vein was present. It went upward between the ascending aorta and the pulmonary trunk, passed through the ventral side of the bifurcation of the pulmonary trunk, and then anastomosed with the left superior vena cava. The oblique vein of the left atrium, as a fibrous bundle, was connected to the junction of the left superior vena cava and the innominate vein in the pericardium. (3) The great cardiac vein was divided into two branches. One was located at the right side of the left coronary artery, forming the origin of the innominate vein. The other extended to the coronary sinus as a normal great cardiac vein. (4) The orifice of the coronary sinus on the right atrium was obliterated. (5) The abnormal orifice existed between the left atrium and the coronary sinus. The formation process and functional significance of such venous variations are discussed.     

Total anomalous pulmonary vein drainage: report of an autopsy case associated with atresia of the common pulmonary vein and left superior pulmonary vein

We describe the clinicopathological features of a case of total anomalous pulmonary vein drainage (TAPVD) associated with atresia of the common pulmonary vein (ACPV). A male Japanese infant born at 37 weeks of gestation demonstrated apnea and severe respiratory acidosis immediately after delivery. The patient died of hypoxemic respiratory failure 6 days after birth despite the initiation of artificial ventilation and administration of a surfactant. Autopsy showed the bilateral inferior pulmonary veins joined with a blind confluence, representing ACPV, accompanied by atresia of the left superior pulmonary vein. Moreover, the anomalous and small right superior pulmonary vein drained into the superior vena cava, consistent with partial and supracardiac type TAPVD. A histological examination of the lungs exhibited diffuse dilation of the lymphatic channels in the peribronchial, interlobular, hilar and focally, subpleural areas. The channels were lined with flattened endothelium which was immunohistochemically positive for D2-40. These findings conformed to a secondary form of pulmonary lymphangiectasis due to the congenital cardiovascular anomalies, including TAPVD and ACPV. To the authors' knowledge, this is the first case of TAPVD associated with ACPV, atresia of left superior pulmonary vein and pulmonary lymphangiectasis.     

A case of anomalous bronchial artery ramified from coronary artery

There have been no anatomical reports on the origin of the bronchial artery derived from the coronary artery. In a 2006 cadaveric dissection course, an anomalous bronchial artery that reached the middle lobe of the right lung from the left coronary artery was observed in an 88-year-old Japanese man. In this specimen, the circumflex branch of the left coronary artery passed under the left auricle in the coronary sulcus and bifurcated to three branches (left marginal branch, posterior left ventricular branch, atrial branch), which were 3.2–3.4 mm in diameter. The atrial branch intersected on the surface of the great cardiac vein, ran along the oblique vein of the left atrium, and reached the atrial side of the transverse pericardial sinus, and then divided into two branches. One of them led to the right atrium. The other branch passed between two right superior pulmonary veins, which derived from superior and middle lobes of the right lung, respectively, through the hilum of the lung along the right superior pulmonary vein derived from the middle lobe, and finally became the bronchial artery in the middle lobe of the right lung. In the middle lobe, the bronchial artery divided into a thin branch along the pulmonary vein for the lateral segment, ran along the surface of the right middle bronchus, and then reached the medial segment, being wedged between the segmental bronchus and vein.     

正常引流肺静脉解剖变异的多层螺旋CT血管成像研究

目的 探讨正常引流肺静脉的解剖变异率及其变异形式。方法 回顾性分析2013年5月—2014年7月中山大学附属孙逸仙纪念医院220例两侧肺静脉均引流至左心房患者的胸部64层螺旋CT血管成像(MSCTA)资料,对肺静脉进行多平面重建(MPR)、最大强度投影(MIP)及VR重建,观察段以上肺静脉引流区域,以及双侧肺静脉与左心房连接模式。两侧肺静脉分别以上、下肺静脉独立开口于左房,右中叶肺静脉回流至上肺静脉者为正常肺静脉引流模式;一侧单支或多于两支肺静脉引流、跨叶引流者为肺静脉解剖变异。结果 220例正常引流肺静脉中,左右肺静脉总变异发生率22.7%(50/220)。右肺静脉解剖变异38例(17.3%,38/220),共见8种变异模式,分别为:(1)上、下叶肺静脉分别汇入左心房,中叶静脉汇入下叶肺静脉 4例(1.8%,4/220);(2)上、下叶肺静脉分别汇入左心房,上叶后段汇入下叶肺静脉2例(0.9%,2/220);(3)上、中、下叶静脉分别汇入左心房16例(7.3%,16/220);(4)上叶后段、尖前段、下叶肺静脉分别汇入左心房,中叶静脉汇入尖前段肺静脉4例(1.8%,4/220);(5)上叶、下叶背段、下叶基底段肺静脉分别汇入左心房,中叶静脉汇入上叶肺静脉2例(0.9%,2/220);(6)上叶、 中叶内段、中叶外段、下叶肺分别静脉汇入左心房6例(2.7%,6/220);(7)上叶后段、上叶尖前段、中叶、下叶肺静脉分别汇入左心房2例(0.9%,2/220);(8)上叶、中叶、下叶背段、下叶基底段肺静脉分别汇入左心房2例(0.9%,2/220)。左肺静脉变异12例(5.5%,12/220),共见2种变异模式,即上、下叶肺静脉组成共干汇入左心房8例(3.6%,8/220),上叶、舌叶、下叶肺静脉分别汇入左心房4例(1.8%,4/220)。220例患者中,左右肺静脉解剖变异率的差异有统计学意义(χ²＝13.533, P<0.01)。结论 MSCTA上正常引流肺静脉解剖变异常见,右肺静脉解剖变异发生率显著高于左肺静脉,且变异模式多样。     

心大静脉异常引流28例CT特征分析

目的 探讨心大静脉异常引流的CT影像特征。方法 回顾性研究。收集2007年5月-2018年8月复旦大学附属华东医院放射科53 185例行心脏CT检查资料中。纳入心大静脉异常引流的患者28例,其中男12例、女16例,年龄25~79岁。患者均采用德国西门子双源CT 进行扫描,对CT扫描图像进行多平面重建,在CT重建图像上观察心大静脉的走行及异常引流的位置,测量心大静脉的长度,心大静脉异常引流汇入上腔静脉处(汇入点)和左心房入口处(入口处)的直径及CT值,以及冠状静脉窦的直径;观察有无合并心脏畸形。结果 28例患者中,心大静脉引流入上腔静脉19例,引流入心房9例(左心房7例、右心房2例)。心大静脉引流入上腔静脉19例患者,心大静脉的长度为17~26 mm,汇入点距离上腔静脉左心房入口处的距离为1~8 mm,汇入点的直径为2.5~4 mm,入口处的CT值为20~60 HU,冠状静脉窦的直径为2.5~5 mm;其中合并的心脏畸形包括室间隔膜部缺损1例。心大静脉异常引流入心房9例患者,其中引流入左心房前壁者6例、右心房顶部靠近房间隔处2例、左心房左侧壁者1例;心大静脉的长度为15~36 mm,入口处的直径为2.8~4.5 mm,入口处的CT值为400~600 HU,冠状静脉窦的直径为2.5~5 mm;其中合并心脏畸形包括无顶冠状静脉窦2例、卵圆孔未闭1例、冠状动脉瘘1例、右室双出口1例。结论 心脏CT检查是发现心大静脉异常引流的有效方法,多种后处理技术相结合可避免漏诊和误诊的发生。     

Variations of the bilateral testicular veins: embryological and clinical considerations

Variations of the bilateral testicular veins were observed during routine dissection of the posterior abdominal wall in a 77-year-old male Japanese cadaver. The right testicular vein consisted of the lateral and medial testicular veins. The right lateral testicular vein drained into the right renal vein. The right medial testicular vein accompanied the right testicular artery to ascend obliquely and drained into the left aspect of the inferior vena cava. The left testicular vein was composed of the lateral, middle and medial testicular veins. Three left testicular veins accompanied the left testicular artery to course cranially and then finally drained into the left renal vein.     

肺静脉畸形

对２５例肺静脉畸形进行分析，其中肺静脉发育不良或闭锁４例，肺静脉共同腔闭锁２例，部分性肺静脉异位引流４例和１５例完全性肺静异位引流。２５例１２例为弧立性畸形，１３例为合并性畸形，如合并单心室畸形、右心室发育不良、室缺或左房双腔等。     

Preureteric inferior vena cava with possible rudiment of the proper inferior vena cava

A right single preureteric inferior vena cava (IVC) was found in the cadaver of a 77-year-old Japanese male during a student dissection course at Kumamoto University School of Medicine in 2003. The ureter emerged from the lower end of the hilum of the right kidney at the second lumbar vertebral level. It ran inferomedially to pass behind the IVC, and turned inferolaterally to cross the vein superficially at the level of the third to the fourth lumbar vertebrae. Then, the ureter was situated to the right of the IVC, and descended ordinarily. The second lumbar vein of each side united bilaterally, as did the third lumbar veins. The common stem of the second lumbar veins drained into the left side of the IVC posterolaterally at the level of the second intervertebral disc, and the third common stem opened into the left border of the IVC at the fourth lumbar vertebral level. The ureter hooked around the IVC between the openings of those common stems. There was a small continuation (0.2 mm in diameter) between the left second lumbar and the right third lumbar veins along the vertebral column slightly right of the midline. It passed superficial to the right third lumbar artery, as did the IVC. The right testicular vein opened into the IVC at the level of the lower end of the third lumbar vertebral body. Generally, the level of the opening of the gonadal vein corresponds to the level of the caudal end of the remaining subcardinal vein, but it is lower than usual in this case. Furthermore, the segment from the confluence of the common iliac veins to the common trunk of the third lumbar veins, and to the small continuation can be regarded as the proper IVC, and the part where the ureter hooks around it may have derived from the anastomosis between the common trunk of the third lumbar veins and the subcardinal vein.     

Bilateral thoracic ducts with coexistent persistent left superior vena cava

A case of bilateral thoracic ducts with coexistent persistent left superior vena cava (SVC) was identified in a 77-year-old Japanese female cadaver during dissection in a gross anatomy course. The persistent left SVC began at the lower surface of the left brachiocephalic vein, descended in front of the aortic arch, and drained into the right atrium through the coronary sinus. The right SVC was normal both in size and in position. The azygos vein, receiving the hemiazygos vein, opened into the right SVC. The accessory hemiazygos vein and the left superior intercostal vein united to form a common trunk, which drained into the left SVC. The left and right thoracic ducts began at the level of the 1st lumbar vertebra, ran upwards parallel and anterior to the vertebral column, and terminated at the venous angles of their corresponding sides. There was an anastomotic branch between them. The present case was considered to be very rare, since the persistent left SVC and bilateral thoracic ducts coexisted. The embryologic basis and clinical importance of this case are discussed.     

小儿颈外静脉穿刺的解剖学研究

目的 :为临床儿科静脉穿刺抽血提供解剖学依据。方法 :在 30例 (6 0侧 )甲醛固定的小儿尸体上解剖并观测了颈外静脉的深度、外径、长度及毗邻关系 ,并与大隐静脉、肘正中静脉进行了对比。结果 :双侧颈外静脉上段的平均深度为 3.6 1± 0 .46 m m,左侧外径为 3.34± 0 .78m m,右侧外径为 3.86± 0 .6 4mm,左侧长度为 35 .6 7± 3.30 mm,右侧长度为 41.6 2± 4.19mm。结论 :小儿浅静脉穿刺抽血应当首选颈外静脉上段 ,次选大隐静脉 ,肘正中静脉基本上不适用于穿刺。     

Simultaneous occurrence of a thyromediastinal muscle,a truncus bicaroticobrachialis,and a left superior vena cava

A case is presented of a combination of anatomical anomalies found in a 67-year-old female cadaver during routine dissection by medical students. They include a thyromediastinal muscle, a truncus bicaroticobrachialis, and a left superior vena cava, with complete absence of the right superior vena cava, but with a normal azygos vein opening into the right atrium at the expected site of entry of the superior vena cava. No associated congenital cardiac malformations were found. Clinical implications include the difficulty of heart catheterization through the subclavian veins and misleading images on CT or MRI scans, where the azygos vein could be mistaken for a right superior vena cava.     

Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: A case report

Multiple venous anomalies have been observed during dissection of the posterior abdominal wall in a 65-year-old, white male cadaver. The left testicular and suprarenal veins united inferior to the superior mesenteric artery, coursed anterior to the abdominal aorta and drained into the inferior vena cava (IVC). Further the left renal vein coursed retroaortically and divided into three branches. The superior branch coursed on the vertebral column and drained into the azygos vein while middle and inferior branches drained into the IVC. The right renal vein was double and both drained into the IVC separately. Due to implications for numerous therapeutical and diagnostic procedures in the retroperitoneal region knowledge of these variations could be useful for clinicians in its recognition and protection.     

The left retro-aortic brachiocephalic vein: morphologic data and diagnostic ultrasound in 27 cases

A left retro-aortic brachiocephalic vein is a rare anatomic entity. A retrospective study was made of 5218 congenital cardiopathies treated between 1982 and 1998 in a medico-surgical department of paediatric cardiology. A left retro-aortic brachiocephalic vein was demonstrated in 27 patients, i.e. an incidence of 0.5%. The chief cardiopathy in these patients was a tetralogy of Fallot in 25 cases (93%). Among these 25 cases of Fallot’s tetralogy the aortic arch was rightsided in 19 cases (70%). The paraclinical diagnosis of this anomaly was facilitated by ultrasonography, provided it was sought for. In this series 6 cases (22%) were discovered during surgery without previous ultrasound diagnosis. The embryological origin of the left retro-aortic brachiocephalic v. differs from that of the venous trunk in its classical anatomic form. It derives from the inferior (but not superior) transverse plexuses, connecting the two anterior cardinal veins. One of the main consequences of this anomaly is its possible confusion with other vascular structures, particularly the right pulmonary artery. Such confusion may give rise to inappropriate surgical procedures. The differential diagnosis is facilitated by the use of the Doppler the venous flow is biphasic and regulated by respiration, whereas the Doppler recording from a pulmonary artery is that of a characteristic systolic arterial flow.     

A case of right partial and double internal jugular veins

We present a very rare case of right partial and double internal jugular veins, found in an 86-year-old Japanese female cadaver during a student dissection practice session in 2002 at Osaka Dental University. In this case, the right internal jugular vein separated into medial and lateral branches at a level with the middle of the fifth cervical vertebra. Both branches had the same thickness as an internal jugular vein and poured into the right subclavian vein. A slender venous space slit was formed by these two branches and the right subclavian vein. The inferior belly of the right omohyoid muscle and the inferior root of the right ansa cervicalis passed through the superior region in this venous space. To our knowledge, this case has never been reported previously. Therefore, we attempted to investigate the incidence based on existing references for similar cases and speculated on the development based on our findings. We considered the medial branch was the right internal jugular vein and the lateral branch was the communicating branch between the external and internal jugular veins.     

Double inferior vena cava with interiliac vein: a case report and literature review

The duplication of the inferior vena cava (IVC) is a rare, but well-recognized anomaly. Duplicated IVC has a significant relevance for retroperitoneal surgery and venous interventional radiology. We report a case of duplicated IVC, which was observed during routine dissection of an 84-year-old Japanese female cadaver. The interiliac vein between the duplicated IVC ran obliquely upwards from left to right. We performed systematic literature review of published reports based on Pubmed and Medline from 1967 to 2011. Of 109 cases with IVC anomalies identified by the literature search, 22 cases (20.2%) displayed no interiliac anastomosis. The interiliac vein connecting duplicated IVC existed in 74 cases (67.9%). According to the running direction of the interiliac vein, we found that the vein ran from left to right in 42 cases, coursed from right to left in 19 cases, and ran horizontally in 13 cases. Thirteen left IVC displayed symmetrical-to-normal connection with the bilateral common iliac veins. Awareness of these venous variations is necessary to reduce surgical risk and to determine strategy in interventional radiology.     

A case with dextrocardia, ventricular septal defect, persistent left superior vena cava and drainage of the great cardiac vein into the left internal thoracic vein

A 17-month-old female patient was operated on for ventricular septal defect and pulmonary stenosis. During the operation several cardiac anomalies were observed these were dextrocardia, ventricular septal defect, persistent left superior vena cava, drainage of the great cardiac vein into the left internal thoracic vein and a pericardial pouch. These anomalies have not previously been reported together.     

Unusual fibrous band on the left aspect of the aortic arch

During dissection of a 63-year-old female cadaver, a firm ribbon-like band was found on the left aspect of the aortic arch. Careful dissection showed that the band (6 cm long, 8 mm wide, 2 mm thick) connected the left superior intercostal vein with the accessory hemiazygos vein. Histological examination showed the fibrous structure of the band and showed the presence of a thread-like vascular lumen. The topography and venous connections of the band indicated its origin from persistence of the embryonic anastomosis between the left superior intercostal and accessory hemiazygos veins. This anastomosis derives from the rostral portion of the supracardinal vein that usually regresses on the left side but forms the terminal arch of the azygos vein on the right side. The severe atherosclerosis present in this patient at the level of the aortic arch may have enhanced the effects of arterial pressure on the adjacent venous anastomotic vessel causing reduction of blood flow and progressive fibrosis. The persistence of this venous anastomosis and its possible age-related fibrosis may have clinical relevance in central venous catheter placement.     

肺动脉切除重建术的应用解剖学

目的:为肺动脉切除与重建提供解剖学基础。方法:选择肺内结节性病灶,直径<3.0cm的周围型肺癌或良性球灶,接受肺叶切除手术的病人,对其肺动脉心包外段的长度、外径、分支及奇静脉各段的长度、外径进行观测。结果:左、右肺动脉出心包返折处至下叶背支动脉起点处的长度分别约为45.7mm、42.8mm;动脉起点处的外径:左侧分别为20.6mm、12.6mm,右侧分别为21.5mm、14.7mm。奇静脉可利用的第1段(奇静脉弓)和第2段的长度分别为44.8mm、46.8mm,第1段两端的外径分别为12.7mm、12.3mm。结论:肿瘤侵犯肺动脉主干及其分支根部,动脉切除后可采用侧壁扩大及袖式吻合重建术。肺动脉侧壁切除缺损较大时,右侧可首选自体奇静脉片;左侧首选心包片进行重建。