Anatomical Variants
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2021 ◽  
Vol 27 (3) ◽  
pp. 55-68
Svetla Dineva ◽  
Milko Stoyanov ◽  
Aneliya Partenova ◽  
Boyan Kunev ◽  
Victoria Stoyanova ◽  

Anatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial fi brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signifi cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after fi rst pulmonary vein isolation.

Aorta ◽  
2021 ◽  
Umberto G. Rossi ◽  
Anna M. Ierardi ◽  
Maurizio Cariati

AbstractWe report the case of a 73-year-old male who underwent abdominal multidetector computed tomography with vascular reconstruction that highlighted a congenital variant of iliac arteries. Iliac artery anatomical variants are exceedingly rare and only a few cases have been reported in the literature.

2021 ◽  
Vol 14 (4) ◽  
pp. 4-18
Aleksandr A. Kuprin ◽  
Viktor Y. Malyuga ◽  
Timur A. Britvin ◽  
Ivan O. Abuladze

Background. The thesis «thyroid surgery is the surgery of the recurrent laryngeal nerve», which was defined in the XX ­century, remains relevant to this day. Thus, despite the use of modern scientific and technological achievements, vocal cord paresis is diagnosed on average in 9.8% patients after thyroid and parathyroid surgery.According to many authors, the main problem which a surgeon encounters is a difficult and sometimes individual anatomy of the recurrent laryngeal nerve. For example, in one study authors identified 28 variants of relationships between the ­recurrent laryngeal nerve and the inferior thyroid artery. In a recent meta-analysis, it was noted that the frequency of extralaryngeal branching remains underestimated and reaches 73% of cases. Anatomical variants of the recurrent laryngeal nerve or its thin branches, which have not been noticed in time, can lead to inevitable consequences — to nerve injury and a laryngeal dysfunctions, and if anatomical features are not detected on both sides — to a tragedy.Aim. The aim of this study is to determine anatomical variants of the extralaryngeal branches of the recurrent laryngeal nerve and their frequency in autopsy case series.Materials and methods. 46 (100%) recurrent laryngeal nerves were dissected in 23 cadavers. Their path was traced, their relationships with the inferior thyroid artery were determined, and the extralaryngeal branches of the recurrent laryngeal nerve were identified.Results. Few extralaryngeal branches of the recurrent laryngeal nerve were identified during dissection: tracheoesophageal branches, laryngeal branches, aberrant branches. Tracheoesophageal branches were determined in all cadavers. In 37 (80.4%) cases the recurrent laryngeal nerve had got two or more extralaryngeal laryngeal branches. In 6 (13.0%) cases aberrant branches were presented.The inferior thyroid artery was detected in 42 (91.3%) cases. The vessel was in close location with the recurrent laryngeal nerve, forming a neuro-arterial chiasm. In 39.1% of cases the recurrent laryngeal nerve was located between the branches of the inferior thyroid artery, in 39.1% of cases — deeper than the artery, and in 10.9% of cases — more superficial than the artery.Conclusion. The variable anatomical configuration of the recurrent laryngeal nerve inevitably causes difficulties during intraoperative nerve dissection. Tardy identification of these anatomical features can lead to the injury of nerves or its branches, which determines the amount of postoperative vocal cord paresis.

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2001
Brandon Pearce ◽  
Elise Porter ◽  
Thomas Preston

2021 ◽  
pp. 5-15
Dmitriy Vladimirovich Lukanin ◽  
Grigory Vladimirovich Rodoman ◽  
Alexey Alexeevich Sokolov ◽  
Marina Sergeevna Klimenko

Among all the anatomical variants for the hiatal hernia development, a true paraesophageal hernia is the most rare. The clinical manifestations of this type of hiatal hernia are caused by the infringement of the diaphragmatic crus or by transient obstruction of the esophagus with the development of organic dysphagia. The leading method of instrumental diagnostics of this pathology is contrast x-ray study of the esophagus and stomach with functional tests. The article describes a clinical case of an incorrect interpretation of the symptoms of the disease and the results of EGD in favor of paraesophageal hernia in association with GERD in a patient with a large white line hernia under conditions of migration into the hernial sac of the stomach and duodenum.

2021 ◽  
Vol 42 (Supplement_1) ◽  
M Ligas ◽  
J Haskova ◽  
R Cihak ◽  
P Peichl ◽  
D Wichterle ◽  

Abstract Background We evaluated the differences in the anatomy of the cavotricuspid isthmus (CTI) by assessing image loops provided by intracardiac echocardiography (ICE) in patients who underwent ablation for atrial flutter and/or atrial fibrillation. Purpose CTI is an essential component of the reentrant circle in isthmus–dependent atrial flutter (CTI-AFL) and a target for catheter ablation. In some patients, CTI anatomy may be responsible for a difficult procedure. The aim of this study is to describe in details the anatomical variants of this structure. Methods We included a group of 138 patients, who underwent cardiac ablation for atrial flutter and/or atrial fibrillation between August 2020 and January 2021. Intracardiac echocardiography was employed during the intervention to evaluate the morphology of CTI. Analysis was focused on size, shape, presence of sub-eustachian pouch (excavation more than 5 mm) or presence of prominent Eustachian ridge (ER, embryologic remnant of the valve of the IVC) and mobility of the structure. Results The length of CTI measured during ventricular systole averaged at 38,4mm (min 22,5mm, max 60mm). The most frequent pattern was a flat CTI without sub-eustachian excavation or with excavation less than 5mm (71 patients; 51.4%). A pouch (excavation more than 5mm) was observed in 41 pts (29.7%), where the deepest pouch reached 10,5mm. Prominent ER was present in 58 pts (42%). The remaining 26 of CTIs (18.8%) were classified in the “unclassifiable” category with deviations from common anatomic variants - substantial convexity, pronounced trabeculation of isthmus or double pouch. We observed 14 CTIs (10.1%), where the structure was partially or in full extent detached from the diaphragm, sliding during cardiac contractions. In addition to the described morphology, Chiari's network was observed in 18 pts (13%). In reference to mobility, 53 pts (38.4%) presented with hypermobile CTI with a difference in size of more than 1/3 between the diastole and systole. Moreover, we looked into differences of CTI related to BMI, left atrial volume index (LAVi) and ejection fraction of the left ventricle. A positive correlation was found between LVEF and mobility of CTI. Hypermobile CTI was present in 42.2% of pts with normal LVEF compared to only 18.9% of pts with reduced EF (EF less than 50%). Similar results were observed in pts with non-dilated LA, where hypermobile CTI was present in 51.9% of pts compared to only 35.1% of pts with dilated LA with LAVi >28 ml/m2 (see table below). Conclusions We observed a substantial differences in the anatomy of the CTI, which could play an important role in catheter ablation of this structure. Besides the prominent ER, significant sub-eustachian pouch and hypermobility appear to be variants predisposing to difficult ablation. FUNDunding Acknowledgement Type of funding sources: None. CTI variants related to EFLV, BMI, LAVi CTI detached from the diaphragm

A.N. Proshin ◽  
V.V. Mashin ◽  
L.A. Belova ◽  
D.V. Belov

The aim of the study is to examine the characteristics of intracranial veins (magnetic resonance angiography), and the elastic-viscous properties of the red blood cell membranes (atomic force microscopy) in adolescents with connective tissue dysplasia. Material and Methods. The authors examined 156 adolescents. The main group consisted of 82 adolescents with connective tissue dysplasia. The comparison group included 74 adolescents without connective tissue dysplasia. Connective tissue dysplasia was assessed according to L.N. Abakumova scale (2006). Magnetic resonance angiography was performed on a Siemens Magnetom Symphony apparatus equipped with a superconducting magnetic system with 1.5 Tesla field strength. Preparations of dry red blood cells were made to study red blood cell cytoplasmic membrane. The specimen was scanned using an atomic force microscope SOLVER P47-Pro. Results. The majority of adolescents from the main group demonstrated anatomical variants of the dura mater sinuses structure. At the same time, sinus hypoplasia in patients of the main group was diagnosed more often than asymmetry of these structures. In the comparison group, the number of anatomical variants of the dura mater sinuses structure also prevailed over the symmetrical structure. However, the sinuses asymmetry was more often. Comparative analysis of Young's modulus values in two groups of patients showed a statistically significant superiority of this indicator in the main group. Correlation analysis of the connective tissue dysplasia severity and Young's modulus values revealed a moderate direct correlation. Conclusion. Thus, it can be assumed that in patients with connective tissue dysplasia the cerebral vessel structure and elastic properties of red blood cell membranes formed during embryogenesis impair the functional and adaptive capabilities of intracranial vessels, contributing to the development and progression of cerebral venous disorders and their subsequent clinical manifestation. Key words: intracranial veins, Young's modulus, connective tissue dysplasia. Цель. Исследовать при помощи магнитно-резонансной ангиографии особенности интракраниальных вен и методом атомно-силовой микроскопии – упруго-вязкостные свойства мембран эритроцитов подростков с соединительнотканной дисплазией. Материалы и методы. Обследовано 156 подростков. Основную группу (ОГ) составили 82 подростка с признаками дисплазии соединительной ткани (ДСТ), группу сравнения (ГС) – 74 подростка без проявлений ДСТ. ДСТ оценивали по шкале Л.Н. Абакумовой (2006). Магнитно-резонансная ангиография проводилась на аппарате Siemens Magnetom Symphony, оснащенном сверхпроводящей магнитной системой с силой поля 1,5 Тесла. С целью изучения состояния цитоплазматической мембраны эритроцитов были изготовлены сухие препараты эритроцитов. Препарат подвергался сканированию, которое проводилось с помощью атомно-силового микроскопа SOLVER P47-Pro. Результаты. У большинства подростков ОГ выявлены анатомические варианты строения синусов твердой мозговой оболочки. При этом гипоплазия синусов у пациентов ОГ диагностировалась чаще, чем асимметрия данных структур. В ГС количество анатомических вариантов строения синусов твердой мозговой оболочки также превалировало над симметричным строением, но чаще диагностировалась асимметрия синусов. Сравнительный анализ значений модуля Юнга в двух группах пациентов показал статистически значимое превосходство данного показателя в ОГ. Корреляционный анализ степени выраженности ДСТ и значений модуля Юнга выявил умеренную прямую корреляцию. Выводы. Можно предположить, что имеющиеся при ДСТ особенности структуры церебральных сосудов и эластических свойств мембран эритроцитов, заложенные в процессе эмбриогенеза, ухудшают функциональные и адаптационные возможности интракраниальных сосудов, что способствует возникновению и прогрессированию церебральных венозных расстройств и их последующей клинической манифестации. Ключевые слова: интракраниальные вены, модуль Юнга, дисплазия соединительной ткани.

P. K. Roopa Rajavarthini ◽  
I. Venkatraman

Multi detector computed tomography (MDCT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery. It depicts the anatomical variations in much simpler way and acts as a roadmap for endoscopic sinus surgery. In this study the maximum of participants were in the age group of 41- 50 years (32 %). The mean age of the study participants was observed to be 43.8 ± 15.6 years. HRCT PNS results shows nasal septum was found to be the most common anatomical variant (DNS- 94%). Concha Bullosa in right side were seen in 37.5% and left side were 21.9% (total unilateral cases- 59.4%) and bilateral Concha Bullosa were seen in 40.6% of the cases. Agger nasi were found to be present in 58% of the CRS cases among which right AN was 41%, left side was 30.8%, and bilateral AN were seen in 28.2% of the cases and Paradoxical Middle Turbinate were seen in 42% of cases in our study. Medialised uncinate was seen in 22% of the cases.

2021 ◽  
Lia Pontes Lisboa Martins ◽  
Paulo Marcelo Gondim Sales ◽  
Adriana de Menezes Gomes ◽  
Marlon Sousa Silva ◽  
Gabriela de Andrade Meireles Bezerra ◽  

Abstract Background: Anatomical variants of brain ventricles are a known marker for abnormal central nervous system development. They seem to be more prevalent in several neuropsychiatric disorders, e.g. schizophrenia, personality disorders, and psychosis. However, knowledge about the risk factors and their overall prevalence in the general population, especially in developing countries is still limited. Methods: We evaluated the prevalence of prevalence of anatomical ventricular variants [Cavum septum pellucidum (CSP), Cavum vergae (CV), and Cavum velum interpositi (CVI)] in 1467 multislice head CTs from two large private hospitals in the city of Fortaleza, Ceará – Brazil. Results: Hospital one had a higher percentage of patients with low-cost health insurance, strokes, and neurocysticercosis (P<0.05). 15.1% of participants in hospital one versus 7.1% in hospital two had at least one type of cerebral cavum, including vestigial CSP. The rarest types of cava (CV and CVI) were twice more common in hospital one (P<0.05). Logistic regression analysis confirmed that patients from hospital one, older patients, and men were more likely to have any type of cerebral cavum and CSP. Conclusions: Anatomical brain ventricular variants (including vestigial CSP) were present in about 12% of participants of this middle-class Brazilian sample while also being more prevalent in male elderly and participants from lower socioeconomic strata. Further studies are necessary to prospectively investigate the association between socioeconomic variables and how they relate to the prevalence of anatomical brain ventricular variants and other known risk factors for developmental disorders.Trial registration: This study was approved by the Institutional Review Board from both participants institutions- Research Ethics Committee (CEP) - Unichristus (Protocols 099/11 and CAAE: 58763716.3.0000.5049).

2021 ◽  
Vol 23 (09) ◽  
pp. 640-645
Vignesh Naachiyappan Meiyappan ◽  
Dr. Naveen Nagendran ◽  
Dr. Karthik Krishna Ramakrishnan ◽  
Dr. Sneha Yarlagadda ◽  

Introduction Agger nasi and haller cells are few of the common anatomical variants of Paranasal Sinuses (PNS) . They can cause obstruction of osteomeatal complex and frontal recess and can cause refractive sinusitis. Also these variants can lead to complications during procedures like Functional Endoscopic Sinus Surgery (FESS). Hence, complete knowledge about these variants and imaging features help in early diagnosis and also helps in avoiding complications during surgery. Materials and Method A retrospective study of 100 patients conducted during the period from January 2021- April 2021 in Saveetha Medical College and Hospital. All the patients included in the study were referred from the department of otorhinolaryngology for Computed Tomography of PNS. All the images were individually analysed and evaluated for occurrence of Agar Nasi cells and Haller cell variants. Results Out of the study population of 100 patients, 56% of the patients were observed for Agger Nasi cells and 19% of the patients were observed for Haller cells. Conclusion Our study concludes that agger nasi and haller cells are found in a significant proportion of the study population. Hence, Identifying these anatomical variants with great accuracy will help in diagnosing and appropriate management of refractive sinusitis and also be critical in supporting surgeons in tailoring surgery for patients when done preoperatively and thereby avoid fatal complications during procedures (1).

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