Costocervical Research Articles

Transient neurologic deficit with complete recovery due to cervical spinal cord infarction after preoperative embolization for metastatic lesion of malignant pheochromocytoma at proximal thoracic spine

Spinal cord infarction after preoperative transarterial embolization for metastatic spinal lesions is uncommon and usually leads to complete paralysis. Transient neurologic deficit due to spinal cord infarction after preoperative embolization for spinal metastases has never been reported in the literature. A 30-year-old female patient was diseased with malignant pheochromocytoma and multiple metastases to lung and bones. She suffered from refractory pain at upper back and numbness at her body below xiphoid process but no motor deficit was noted at extremities. Magnetic resonance imaging (MRI) revealed paraspinal and epidural lesions originating from T2 to T4 vertebrae with compression to spinal cord. Preoperative embolization was executed to the spinal metastases with the intent to reduce intraoperative bleeding. Embolization procedure was performed to bilateral costocervical trunk, 3rd and 4th intercostal arteries with 400 μm Embozene® microsphere under local anesthesia. The procedure was discontinued immediately after development of severe hypertension that might be related to the pheochromocytoma and was treated with intravenous antihypertensive drug. There was no neurologic deficit until 6.5 hours after the procedure when weakness at right lower extremity and hypesthesia at left arm developed. Emergent MRI showed focal infarcts in spinal cord at right aspect of C5 and left C4 levels. With adequate hydration but no administration of steroid, muscle power gradually recovered in a few hours. Posterior instrumentation, neural decompression and tumor debulking were performed 2 days after embolization as scheduled. One week after the event of spinal cord infarction, she could stand up and walk without aid. Even though it is rare, spinal cord infarction is an important differential diagnosis for sudden decrease of muscle power after preoperative embolization for spinal metastases. Although complete paralysis is more common, transient neurologic deficit with complete recovery could happen in patients with minor infarcts in the spinal cord.

Four collateral circulation pathways were observed after common carotid artery occlusion

BackgroundCommon carotid artery (CCA) occlusion (CCAO) is a rare condition. Owing to collateral circulation, ipsilateral internal carotid artery (ICA) and external carotid artery (ECA) are often patent.MethodsThis study included 16 patients with unilateral CCAO and patent ipsilateral ICA and ECA. The pathways which supplied ICA were investigated by digital subtraction angiography (DSA), transcranial Doppler (TCD), magnetic resonance angiography (MRA) and computed tomography angiography (CTA).ResultsIn all 16 patients, TCD found antegrade blood flow in ipsilateral ICA, which was supplied by retrograde blood flow in ipsilateral ECA through carotid bifurcation. We call this phenomenon “ICA steal”. DSA and CTA discovered four pathways of ICA steal, including 1) ipsilateral vertebral artery – occipital artery – ECA – ICA, 2) ipsilateral thyrocervical trunk or costocervical trunk – ascending cervical artery or deep cervical artery – occipital artery – ECA – ICA, 3) contralateral ECA – contralateral superior thyroid artery – ipsilateral superior thyroid artery – ipsilateral ECA – ICA, and 4) ipsilateral thyrocervical trunk – inferior thyroid artery – superior thyroid artery – ECA – ICA.ConclusionsICA is possible to be patent and supplied by several collateral circulation pathways after CCAO.

Rare Bilateral Variation of the Posterior Intercostal Arteries

BackgroundThe thoracic aorta usually gives off the 3rd to 11th pairs of posterior intercostal arteries (PIA) and 1 pair of subcostal arteries. The first two pairs of PIA typically originate via the highest intercostal artery via the costocervical trunk of the subclavian artery. The PIA supply blood to the intercostal spaces, spinal cord and spinal nerve roots.A bilateral branching anomaly in multiple PIA were observed in an 81 year‐old male cadaver during routine dissection. The thoracic aorta gave rise to asymmetrical common PIA trunks at different levels on both sides. Five common PIA trunks were found arising from the thoracic aorta and a descending branch of the right vertebral artery was also observed. Two common PIA trunks were observed on the right side branching from the thoracic aorta. The first common PIA trunk supplied the 4th through 7th intercostal spaces while the second common PIA supplied the 10th and 11th intercostal spaces. The 8th and 9th PIAs were direct branches off the thoracic aorta as normal. Three common PIA trunks were observed on the left side originating from the thoracic aorta. The first common trunk supplied the 3rd through 5th intercostal spaces. The second supplied the 6th and 7th intercostal spaces. The third trunk was observed to supply the 11th intercostal space as well as the subcostal region. Another vascular variation observed included a branch from the right vertebral artery that descended inferiorly and dorsally toward the first four ribs through the right costotransverse foramen. This descending branch of the vertebral artery gave off branches to supply the second, third, and fourth intercostal spaces on the right side. While common trunks of PIA have been reported to be highly prevalent, there are normally 1–2 common trunks found in a typical thorax. Thus, a cadaver that displays up to 5 common trunks of PIA in a singular thorax is a rare occurrence. Also anomalous is the presentation of a direct branch of the vertebral artery that courses dorsal to ribs while supplying several intercostal spaces. Understanding such anomalies has important clinical implications to interventional radiologists during thoracic cavity procedures as well as spine and thoracic surgeries.Support or Funding InformationCenter for Anatomical Science and Education, Department of Surgery, Saint Louis University School of MedicineThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Various branching patterns of the aortic arch in the Siberian roe deer (<i>Capreolus pygargus</i>, Pallas, 1771) on Jeju Island

This study examined and compared the branching pattern of the aortic arch (AA) and its major branches in the Siberian roe deer (Capreolus pygargus) on Jeju Island (Jeju roe deer [JRD]) with those in the roe deer of the Korean peninsula (mainland roe deer [MRD]). Seven of the nine expected types was observed in the arterial silicone casts of 29 deer (10 males, 19 females). The JRD was identical to the MRD in that absence of the typical pattern; however, the main three pattern types differed between the two. This difference resulted from differences in the branching patterns of the right subclavian artery and costocervical trunk. In conclusion, the JRD has different type of AA from the MRD.

Collateral Arteries of the Aortic Arch in Mongolian Gerbil (Meriones unguiculatus)

Background: Gerbils (Meriones unguiculatus) are rodents belonging to the Muridae family. Recently, breeding of this species as pets has increased significantly. Animal models are being investigated to study diseases related to the human aortic arch. Despite the importance of the aortic arch in maintaining homeostasis, there is limited data available regarding its morphology in gerbils. This study was performed with the objective of describing the collateral branches of the aortic arch in this animal to establish a standard model and thus contribute to future research on cardiovascular diseases in humans.Materials, Methods & Results: This study used 20 male specimens from previous studies that were frozen and stored at the Laboratory of Veterinary Anatomy of the Federal Rural University of the Semi-Arid Region. After thawing the animals, the thoracic cavity was opened for aortic cannulation. The vascular system was washed using saline solution and Neoprene latex stained with red pigment was injected. Subsequently, the animals were fixed in 10% formaldehyde and were dissected and analyzed 72 h later. The arrangement of the collateral branches of the aortic arch in gerbils was analyzed in all animals. The brachiocephalic trunk, the left common carotid, and the left subclavian artery were observed to originate as collateral branches. The brachiocephalic trunk bifurcated into the right common carotid and the right subclavian arteries. The right and the left subclavian arteries branched into the vertebral artery, the internal thoracic artery, the superficial cervical artery, the costocervical trunk, and the axillary artery.Discussion: Several studies reported in the literature describe the collateral branches of the aortic arch in domestic and wild mammalian species. These studies examined the main arteries that originate directly from the aortic arch and their respective branches, and classified the different anatomical variants of the aortic arch in each species. Three different arrangements have been commonly described. The first type corresponds only to the brachiocephalic artery originating from the aortic arch. The right and the left common carotid arteries and the right and the left subclavian arteries originate from this brachiocephalic artery. This type has already been described in the laboratory rat, catingueiro-deer, cattle, and horses. The second type is characterized by the presence of 2 arteries - the brachiocephalic trunk and the left subclavian artery. The right and the left common carotid arteries and the right subclavian artery originate from the brachiocephalic trunk. This arrangement has been reported in most species already studied such as rodents including the paca, chinchilla, guinea pig, mocó, nutria and the preá. The third type of vascular arrangement is observed in the gerbil. In this species, 3 collateral arteries originate from the aortic arch (the brachiocephalic trunk, the left common carotid, and the left subclavian artery). The right common carotid and the right subclavian artery originate from the brachiocephalic trunk. This vascular model has been described in the manatee, in humans, mice, sauim, and the monkey-nail. Thus, we concluded that the branching pattern of the aortic arch of the gerbil was characterized by the brachiocephalic trunk, the left common carotid, and the left subclavian artery, as has been described in mice, the manatee, monkey-nail, sauim, and humans. Based on these morphological characteristics, gerbils could serve as potential experimental models to study diseases related to the human aortic arch.

Variable anatomic configuration of the posterior spinal arteries in humans.

Posterior spinal arteries (PSAs) arise from the vertebral (VA) or posterior inferior cerebellar (PICA) artery. We identified variations in their origins and their anastomosis with the first posterior radiculomedullary branches in human spinal cords. Spinal cords from male and female cadavers (n = 30) were injected with colored latex through the vertebral, ascending cervical, costocervical trunk and segmental arteries. Specimens were fixed in formalin and the spinal arteries were dissected under a surgical microscope. PSAs arise from the PICA and from the atlantoaxial (V3) or intracranial (V4) segments of the VA. Their origins can be at V3 between the axis and the transverse processes of the atlas (V3i) or between the processes and the occipital bone (V3s). Half of our specimens exhibited a symmetrical and half an asymmetrical origin of the PSAs. A symmetrical origin from V4 was the most common configuration, identified in 30% of specimens. There was a symmetrical origin from either segment of V3 or PICA in 10%. Asymmetrical configurations were observed from V4/V3 (23.7%), V3/PICA (16.7%), V4/PICA (6.7%) and V3i/V3s (3.3%). PSAs are supplied by the posterior radiculomedullary arteries along the spinal cord. The first of these anastomoses could be located at any level between C4 and T8, though most commonly at C6-C7 or T3-T4. PSAs can originate from either the VA or the PICA in a symmetrical or asymmetrical configuration. Variations in the origin and level of the first posterior radiculomedullary anastomosis could affect surgical approaches, endovascular procedures, and the posterior spinal cord's susceptibility to ischemia. Clin. Anat. 31:1137-1143, 2018. © 2018 Wiley Periodicals, Inc.

Anatomical Studies of the Recurrent Laryngeal Nerve and the Subclavian Artery in Rough-Toothed Dolphins (Steno bredanensis) and Pacific White-Sided Dolphins (Lagenorhynchus obliquidens)

In mammals, the recurrent laryngeal nerve (RLN) loops around the ligamentum arteriosum on the left side and around the subclavian artery on the right side. It is generally considered that such an asymmetric arrangement of the right and left RLN is brought about by a transformation of the aortic arches at an early stage of embryonic development. We have dissected rough-toothed dolphins and Pacific white-sided dolphins in this study. In both species, the right RLN hooked around the costocervical trunk, while the left RLN hooked around the ligamentum arteriosum. The external carotid artery, the internal carotid artery, the subclavian artery, and the costocervical trunk arose radially from the brachiocephalic trunk on the right side. The left costocervical trunk arose directly from the aortic arch. The right and left subclavian arteries ran ventral to the subclavian vein and the vagus nerve, in a similar manner to the secondary subclavian arteries in birds. These findings suggest that the replacement of the primary (or dorsal) subclavian artery by the secondary (or ventral) subclavian artery might occur at a certain embryonic stage in dolphins as well.

Branching patterns of the aortic arch in the Siberian roe deer (Capreolus pygargus Pallas, 1771).

This study examined the branching pattern of the aortic arch (AA) and its major branches in the Siberian roe deer (Capreolus pygargus Pallas, 1771) from South Korea. A total of eight of the nine expected types, based on the branching site and bilateral levels of the costocervical trunk (CCT) and subclavian artery (SB), were observed in the arterial silicone casts of 35 deer (16 males, 19 females). This deer has no typical type. The three most common types were present in 28.6, 25.7 and 20.0% of cases and resulted from different branching patterns of the left CCT and left SB. These results suggest that the Siberian roe deer in the Korean peninsula has various AA branching patterns, which differs from other ruminants.

The Branching Pattern of the Brachiocephalic Trunk in the Donkey (Equus asinus).

Donkeys are a member of the horse family (Equidae) and share a common ancestor. However, in morphological terms, donkeys and horses are regarded as two separate subgenus. Given variations in the branching pattern of the brachiocephalic trunk (BCT) in different species of animals and the use of donkeys in anatomy courses at colleges of veterinary medicine, we conducted this study in order to investigate the branching patterns of BCT and to describe detailed morphological information regarding donkeys. Seventeen mature donkeys were examined following euthanasia by exsanguination from the common carotid artery under general anaesthesia. Thirteen donkeys were embalmed and injected with coloured latex from BCT origin for better visualization of vessels. Four other donkeys were freshly studied without the embalming procedure. In all cases, the BCT was the only branch of the aortic arch and branched into the left subclavian (LSb) artery, the right costocervical trunk, the right subclavian (RSb) artery and the bicarotid trunk. The main branching pattern of the RSb was the costocervical trunk, the vertebral artery, the internal thoracic artery and the superficial cervical artery. The deep cervical artery branched from the costocervical trunk. The major branching pattern of the LSb was the vertebral artery, the internal thoracic artery and the superficial cervical artery. In donkeys, the external thoracic artery branches from the internal thoracic artery. Results obtained from this study indicate that BCT branching in donkeys has some similarities and differences as compared to that in horses and in the Caspian miniature horse.

Aortic arch in rabbits: Morophological and Histological study

The study aimed to investigate the morphological and histological variations of the aortic arch of local breed rabbits (Oryctylagus conniculus). Nine adult local rabbits were obtained to study the aortic arch (four animals for corrosion cast technique, two injected with colored latex and three for histological study). All the rabbits were euthanized and exsanguinatd, for the cast of the aortic arch they injected by self polymerizing resin via the left ventricle of the heart and the specimens were macerated in (KOH %25) for two weeks and the cast of the aortic arch were prepared. Two main branches were identified from aortic arch (except in one cadaver has three branches). The brachiocephalic trunk firstly and the left subclavian artery, the two common carotid artery (right and left) and the right subclavian artery arising from brachiocephalic trunk, the right and left subclavian arteries gave the same branches (double vertebral arteries, costocervical trunk, cervical profound artery, internal thoracic artery, external thoracic artery, superficial cervical artery and continuous as axillary artery). Histologically the wall of the aortic arch is consist of three layers from internal to external: tunica intima, it's the thinnest layer (1±0.166) µm, tunica media, it's the thickest layer (12±0.0149)µm and tunica adventitia, the thickness of this layer is (5±0.166)µm. Tunica intima consisted of single layer of endothelial cells, tunica media consisted of numerous elastic lamina in a circular arrangement and the tunica adventitia was consisted of connective tissue, smooth muscle fibers, collagen fibers, few elastic fibers, fibroblast cells, and mast cells vasavasorum. The aortic arch has a large diameter (98±0.2019)µm and thickness of the wall is (18±0.0282)µm to convey the high blood pressure in aortic arch. In conclusion, there was a variation in the branches of the aortic arch in different species of animals when the results compared with other studies and also, the diameter, thickness of the wall of aortic arch varies from one animal to another.

Ramescência do arco aórtico no gambá-de-orelha-branca (Didelphis albiventris)

O conhecimento do comportamento das artérias que emergem do arco aórtico é importante, pois estas artérias irrigam órgãos vitais encontrados na cabeça, pescoço, cavidade torácica e membros torácicos de animais domésticos e selvagens. Com o objetivo de contribuir com o conhecimento anatômico em gambás e colaborar com a clínica médica e cirúrgica de animais selvagens, descreveu-se neste estudo, a ramescência do arco aórtico em dezoito gambás. Os resultados indicaram que o tronco braquiocefálico e a artéria subclávia esquerda se originaram do arco aórtico em todos os animais estudados. Este padrão de ramescência do arco aórtico é similar ao descrito para a cobaia, chinchila, paca, mão-pelada, nutria, esquilo-vermelho e jaguatirica. O tronco braquiocefálico apresentou como ramos colaterais, a artéria subclávia direita e o tronco bicarotídeo, o qual se bifurcou nas artérias carótidas comuns direita e esquerda (77,7%). O tronco bicarotídeo não apareceu em quatro animais (22,2%). As artérias subclávias direita e esquerda originaram a artéria vertebral, o tronco costocervical e, as artérias torácica interna e cervical superficial. A ramescência encontrada nas artérias subclávias do gambá mostrou similaridades quando comparada com a descrita para outros animais selvagens como a paca, jaguatirica e o mocó.

Ramos colaterais do arco aórtico e suas principais ramificações no cachorro-do-mato (Cerdocyon thous)

Resumo: O cachorro-do-mato (Cerdocyon thous) pertence à família Canidae, encontra-se amplamente distribuído pela América do Sul. Devido à escassez literária a respeito da morfologia desta espécie objetivamos colaborar com o conhecimento da anatomia do arco aórtico e seus ramos colaterais. Foram estudados quatro animais, sendo 2 machos e 2 fêmeas oriundos da Mina de Bauxita, Paragominas, Pará, Brasil/Terra Ltda, sob autorização da SEMA-PA nº 455/2009, que morreram por causas naturais. O sistema arterial foi preenchido com látex corado em vermelho e fixado em solução aquosa de formoldeído 10%. O arco aórtico de Cerdocyon thous apresentou em sua origem apenas dois vasos, o tronco braquiocefálico e a artéria subclávia esquerda. Do tronco braquiocefálico originou-se o tronco bicarotídeo, que se bifurcou nas artérias carótidas comum direita e esquerda, e artéria subclávia direita. Das artérias subclávias ocorreu a formação do tronco costocervical, artéria vertebral, artéria torácica interna, artéria cervical superficial e ao atingir o espaço axilar passa a ser chamada de artéria axilar em ambos os antímeros. Concluímos que o arco aórtico de Cerdocyon thous é similar ao de outros animais domésticos com relação ao número de ramificações em sua origem.

Anatomical description of the aortic arch of a rare species "the giant armadillo" (Priodontes maximus; Kerr, 1792).

The giant armadillo (Priodontes maximus) is found in diverse habitats from South America. A female adult giant armadillo with a body mass of 45 kg was used. The animal was a victim of trampling on highway AC-40, at 70 km, near the municipality of Capixaba-Acre and the corpse donated to the Animal Anatomy Laboratory at Federal University of Acre (UFAC). The arterial system was filled with natural latex via the thoracic aorta in a direction opposite the blood flow to facilitate the description of the aortic arch and its side branches. The study was approved by CEUA/UFAC - no. 053/2015 and SISBIO no. 47124-1. The aortic arch issued side groups, which had the following sequence: brachycephalic trunk, left carotid artery, left subclavian artery. The brachycephalic trunk forked forming the right subclavian artery and the right common carotid artery. The arrangement allowed the whole carotid blood supply to the brain and surrounding structures present in the animal's head. The subclavian arteries, of homologous way, originated the arteries: vertebral, thoracic, and cervical costocervical trunk. The aortic arch armadillo showed the same pattern as that described for the Euphractus sexcinctus and different from those reported for the Dasypus novemcinctus and Tamandua tetradactyla. In addition, the function assigned to each branch was the same regardless of the species with which it was compared.

Ramos colaterais do Arco aórtico do preá (Galea spixii Wagler, 1831)

Resumo: O preá é um roedor típico da caatinga pertencente à família Caviidae. Considerando a inexistência de dados sobre o arco aórtico do preá, foi realizado este estudo tendo como objetivo descrever os ramos colaterais do arco aórtico neste cavídeo, e dessa forma, contribuir com dados para biologia da espécie. Foram utilizados vinte preás machos provenientes de estudos anteriores e encontravam-se armazenados em freezer no Centro de Multiplicação de Animais Silvestres (CEMAS/UFERSA). Os animais foram descongelados, a cavidade torácica foi aberta, a aorta canulada e o sistema vascular lavado com solução salina e em seguida, injetado látex Neoprene corado com pigmento vermelho, amarelo ou branco. Posteriormente, os animais foram fixados em formol e depois de 72 horas, dissecados e analisados, sendo obtidos desenhos esquemáticos e os exemplares mais representativos fotografados. O arco aórtico do preá emitiu como ramos colaterais, o tronco braquiocefálico e a artéria subclávia esquerda. O tronco braquiocefálico originou na maioria das peças estudadas, a artéria carótida comum esquerda e o tronco braquiocarotídeo, do qual surgem as artérias subclávia direita e carótida comum direita. As artérias subclávias direita e esquerda em todos os animais estudados emitiram a artéria vertebral, a artéria torácica interna, a artéria cervical superficial, o tronco costocervical e a artéria axilar. O padrão da formação do arco aórtico do preá assemelhou-se ao observado em outros roedores, tais como no mocó, no porquinho-da-índia e na chinchila.

2062511 High-Frequency Ultrasound Examination of The Deep Cervical Artery

2062511 High-Frequency Ultrasound Examination of The Deep Cervical Artery

Various branching pattern of aortic arch in the Siberian roe deer (543.7)

This study examined the branching pattern of the aortic arch and its major branches in Siberian roe deer (Capreolus pygargus) and compared its branching patterns with those of other ruminants. Silicone casts were taken from 16 carcasses (male 7, female 9) with body weights ranging from 7.70~26.35 kg. Silicone casts of the vessels were made by a retrograde injection into the abdominal aorta. Only the brachiocephalic trunk (Bct) branched from the aortic arch in all carcasses. The left costocervical trunk (LCct) branched off as the first branch of Bct in 2 cases, but, in 9 of the 16 cases, the LCct and the left subclavian artery (LSb) were branched off first at the same level; rest 5 case had LCct from LSb. The right costocervical trunk (RCct) branched separately off before the right subclavian artery (RSb) was exhibited in 7 cases. The case that Bct trifurcated into the bicarotid artery (Bc), the RCct and the RSb was observed in 3 cases; however, Bct bifurcated in to Bc and RSb from which the RCct branched off as the first artery were showed in 5 cases. The right common carotid artery (RCc) branching at same site with RCct so that having no Bc was observed in only 1 case. In 4 cases the highest intercostal artery (Hi) formed the common trunk with the dorsal scapular artery (Ds). The combination in these different branching orders of costocervical trunk in both side and the formation of common trunk of Hi and Ds resulted in 12 types of the branching patterns in Siberian roe deer. These results suggest that the Siberian roe deer has a Bct with various branching patterns and its types are different with those of other ruminants.Grant Funding Source: Supported by NRF‐2013028138

The supreme intercostal artery includes the last cervical intersegmental artery (C7) ‐ angiographic validation of the intersegmental nomenclature proposed by Dorcas Padget in 1954

In 1954, Dorcas Padget wrote a note that settled the debate over the labeling of the intersegmental arteries (ISAs) and the level of origin of the subclavian artery (SubA), in agreement with earlier observations made by Hochstetter in the rabbit (1890) and Schmeidel in man (1932). In her proposed nomenclature, Padget introduced the name of proatlantal artery and confirmed that the SubA was associated with the sixth ISA rather than the seventh. However, a generally unnoticed consequence of this now widely accepted terminology lays in its incompatibility with the traditional view of the costocervical trunk (CT), regarding in particular the anatomy of the supreme intercostal artery (SIA). If the SubA derives from the sixth cervical ISA (ISA 6), and the CT provides the first and second posterior IAs (ISA 8 and 9), the seventh cervical ISA (ISA 7) then remains unaccounted for. The purpose of this study was to examine Padget's nomenclature in the light of modern angiographic material to identify the missing seventh ISA. Our findings validate the terminology used by Padget, including the addition of a pro-atlantal artery and the identification of the ISA most commonly associated with the SubA as the sixth ISA, but they also emphasize the need to redefine the anatomy of the SIA to incorporate the seventh cervical ISA.

Arterial Thoracic Vascularization in Some Deer Species: Pampas Deer (Ozotoceros bezoarticus), Brown Brocket Deer (Mazama gouazoubira) and Axis Deer (Axis axis)

In this study, the arterial distributions of the aortic arches of three deer species (Axis axis, Ozotoceros bezoarticus and Mazama gouazoubira) were described. The animals were dissected immediately after being found dead. Latex injection method was used to observe the vascularization of the thorax. The branching pattern of the arteries of the thoracic aorta in O.bezoarticus was similar to domestic ruminants. In the M.gouazoubira and A.axis, there were no bicarotid trunk. Interestingly, the first branch of the brachiocephalic trunk was the left costocervical trunk in A.axis. Then, brachiocephalic trunk was divided into right and left subclavian arteries. M.gouazoubira and A.axis in contrast to O.bezoarticus were different when compared with other ruminants, and the absence of bicarotid trunk was more striking than previous reports.

Endovascular Coil Embolization of a Costocervical Trunk Pseudoaneurysm After Bullectomy With Pleural Abrasion

Transarterial embolization (TAE) is less invasive than surgery for the treatment of pseudoaneurysms. Costocervical trunk (CCT) pseudoaneurysms are extremely rare. We herein report an unusual case of a 45-year-old man with a CCT pseudoaneurysm caused by a bullectomy with pleural abrasion, which had been performed to manage a spontaneous pneumothorax. The patient presented with chronic chest pain and successfully underwent TAE with a metallic coil. The chest pain completely disappeared 2 weeks after the TAE, and follow-up computed tomography showed that the pseudoaneurysm had almost completely disappeared 9 months after the TAE.

Bilateral subclavian origin of the bronchial arteries combined with absence of other origins

There are numerous anatomical variations of the sites of origin of the bronchial arteries (BAs). A subclavian origin of a BA involves an aberrant artery that originates from the subclavian artery (SCA) or its branches. However, the aberrant artery usually originates directly from the SCA, and an SCA-origin BA arising from the branches of the SCA is rare. We herein present an extremely rare case of a right BA arising from the ipsilateral costocervical trunk, and a left BA arising from the ipsilateral thyrocervical trunk, in the absence of other origins of the BA. This anatomical variation was detected during pretherapeutic evaluation by multidetector-row computed tomography and confirmed by selective angiography. Recognition of these anatomic variations is important to surgical, diagnostic, and interventional radiologic procedures in the thorax.