Variations In Branching Pattern Research Articles

Accessory Left Lung Fissure with Rare Branching Pattern of Bronchial Tree

Pulmonary fissures separate bronchopulmonary segments and delineate lungs into lobes Anatomical variation of these fissures lie on a continuum from completely fused lobes to accessory fissures in about 17.5% of right and 2% of left lungs. Hilar variations in the bronchial tree and vasculature can also be seen in lobar abnormalities.A routine dissection of an 83‐year‐old male cadaver showed an accessory fissure in the left lung. The hilum of the lung was further dissected for visualization of the bronchial tree and vasculature to explore mediastinal relationships and bronchopulmonary segments. Photographs were taken after dissection. The completeness of the accessory fissure and position of the pulmonary artery were classified using the Craig and Walker Scale.An accessory horizontal fissure forming a complete visceral cleft divided the superior and inferior lingular bronchopulmonary segments of the left lung. However, the fissure did not extend into the hilum at its base and may be classified as a Grade 2 fissure, a “complete visceral cleft but parenchymal fusion at the base.” While the pulmonary artery was positioned normally with reference to oblique fissure, the main and superior lobar bronchus showed variant branching pattern. The left main (primary) bronchus gave rise to the superior and inferior lobar (secondary) bronchi prior to entering the hilum. A normal division of the superior lobar bronchus was observed anterior to the pulmonary artery. The lingular branch of the superior lobar bronchus trifurcated into a rare accessory posterior segmental bronchus in addition to the normal superior and inferior segmental (tertiary) bronchi. The superior and inferior lingular bronchopulmonary segments separated by the accessory fissure were supplied by superior and inferior segmental bronchi, respectively, while the rare accessory posterior segmental bronchus supplied the base of the accessory fissure. The inferior lobar (secondary) bronchus showed normal division and was situated posterior to the pulmonary artery in the hilum. The mediastinal relationships showed the left pulmonary artery posterosuperior instead of anterosuperior to the main bronchus. No cardiac abnormalities were observed.Fewer structural abnormalities have been reported in the left lung in comparison to the right. Bilateral isomerism of the lungs is often associated with heterotaxia, wherein other structures in the chest and abdomen are also altered. In this case, while the left lung had two fissures similar to a right lung, there is no evidence of heterotaxia, suggesting that the abnormality arose from lung bud branching unilaterally during pulmonary development. Knowledge of possible accessory fissures and variant segmental bronchial branching is of clinical importance in understanding the pathological conditions, particularly for radiologists conducting imaging studies and pulmonologists and surgeons conducting bronchoscopies, biopsies and balloon bronchoplasties to place airway stents and lobectomies.Support or Funding InformationSupport from Touro College of Osteopathic Medicine.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Clinically Relevant Variations in the Branching Pattern of Arch of Aorta - Research Article

Anatomical variations in the branching pattern of arch of aorta are significant for diagnostic, surgical, and interventional procedures of the thorax and neck and the aim of the study is to analyze the anatomical variations in the branching pattern of arch of aorta. The purpose of this study is to review the anatomical variations in branching pattern of arch of aorta in fifty adult human cadavers (M: 42, F: 8) dissected in the department of anatomy, Siddhartha medical college, Vijayawada for five consecutive years from 2013 to 2017. The three branches of the arch of aorta were normal in 41 cadavers in the present study. In 9 cadavers, the variations were observed. In five male cadavers and in a female cadaver, the two branches of arch of aorta were the common trunk of brachiocephalic trunk and left common carotid artery and the left subclavian artery. In two male cadavers, the branches were four including the origin of left vertebral artery from arch of aorta. In a female cadaver, the three branches of arch of aorta were as follows: common trunk of brachiocephalic trunk and left common carotid artery, the left vertebral artery and the left subclavian artery. Head and neck surgeons and interventional radiologists should be aware of aortic arch variations. Computerized tomography angiography is a reliable imaging method for demonstrating anatomical features and variations of the arch of aorta.

An unusual branching pattern of the axillary artery

Variations in the branching pattern of axillary artery are frequently found. Knowledge about the variations in the branching pattern of Axillary artery is important for surgeons to avoid intraoperative injuries in axilla. An unusual unilateral variation in branching pattern of axillary artery was found during routine undergraduate dissection in Medical College & Hospital, Kolkata. Variation consist of origin of a common arterial trunk from the 2nd part of axillary artery which was giving rise to 4 branches namely, Anterior & Posterior circumflex humeral artery, Arteria profunda brachii and superior ulnar collateral artery, rest of the branches were as usual.

Study of Middle Cerebral Artery in Human Cadaveric Brain.

Background:Middle cerebral artery (MCA) is the larger terminal branch of the internal carotid artery. It travels through the Sylvian fissure on the insula.Objective:MCA supplies a large area of distribution than the other two cerebral arteries. Though it is so, there are very few articles in the literature describing MCA. Aim of the present work is to study the MCA regarding its origin, course, termination, branching pattern, morphometry and symmetry.Materials and Methods:340 MCAs from 170 formalin preserved brains were dissected. Morphology, morphometry and symmetry of MCAs, were studied in detail and well photographed. The data collected in the study was analyzed.Results:Accessory MCA was found in seven specimens (2.05%). Duplicated MCA was seen in three specimens (0.88%). Aneurysm was found in three specimens (0.88%). MCA with bifurcated, trifurcated, quadrifurcated and single trunk termination was seen in 220 (64.70%), 42 (12.35%), 8 (2.35%), and in 70 (20.58%) specimens respectively. Bifurcated pattern as upper prominent trunk (type A), lower prominent trunk (type B) and both equal prominent trunks (type C) were seen in 63 (28.63%), 129 (58.63%), and 28 (12.72%) specimens respectively. Asymmetry was seen in 102 specimens (60%). Mean length and diameter of the MCA was 25.5-27.8 mm and 3 mm respectively.Conclusion:Awareness of these anatomical variations in branching patterns is important in neurovascular procedures. As very few Anatomical studies on MCA are there in the literature, this type of research work should be done by a number of scientists from a different region of the world in large scale.

Clinically relevant variations in branching pattern of axillary nerve

Clinically relevant variations in branching pattern of axillary nerve

Anatomical and radiological evaluation of the variation in the branching patterns and morphology of the aortic arch in the irish population- A morphometric study

Introduction: Anatomical variations of the aortic arch are clinically significant for diagnostic and surgical procedures in the mediastinum. Our objective was to determine the arch morphology and incidence of variant branching patterns in both a cadaveric and patient population. Materials and Methods: 194 CT scans were retrospectively analysed for branching variations and arch type. 18 cadavers were dissected with variations noted. Results: Analysis of scans revealed normal branching in 77.32%, bovine arch pattern in 14.43%, direct origin of the left vertebral artery in 7.73% and a bovine arch with direct origin of the left vertebral artery in 0.52%. A significant correlation (p<0.0001) was found between arch type and age, with the mean age of a type 1 arch 51.1 years, type 2 arch 60.7 years, and type 3 arch 70.7 years. Direct origin of the left vertebral artery was found in one cadaver. Conclusion: Correlation between arch type and age strengthens the concept of age-related unfolding of the aortic arch. A detailed understanding of the branching variations of the arch is important in the disciplines of anatomy, radiology and cardiothoracic surgery.

Branching pattern variations of the celiac trunk and superior mesenteric artery in a 72-year-old white female cadaver

Variations in the branching patterns of the celiac trunk and superior mesenteric artery occur frequently. Detailed knowledge of anatomical variations of the abdominal arterial supply is important for the outcome of abdominal organ surgical intervention, abdominal aortic aneurysm repairs, liver resections, oncologic evaluations and chemoembolization of hepatic tumors. Familiarity with such variations is equally important for instructors teaching anatomy to students in the various medical disciplines. Case studies highlighting such vascular variations provide anatomical instructors and surgeons with accurate information on the types and prevalence of such alterations. This article highlights branching pattern variations of the celiac trunk and superior mesenteric artery involving the left and right hepatic arteries of a 72-year-old White Female cadaver. The left hepatic artery was one of the branches of the celiac trunk instead of the common hepatic artery, and the right hepatic artery was a branch of the superior mesenteric artery.

Ventral Approach to the Middle Hepatic Vein During Laparoscopic Hemihepatectomy.

The caudal approach constitutes a conceptual change in laparoscopic hepatectomy.1-4 The middle hepatic vein (MHV) located in the midplane of the liver serves as a landmark during hemihepatectomy.5 However, it is difficult to expose the MHV from its peripheral branches toward the main root via the caudal approach because of anatomical variations in branching patterns.6 We present the ventral approach to the MHV during laparoscopic hemihepatectomy. The ventral approach involves liver transection from the ventral to the dorsal aspect using a flexible laparoscope, similar to an open hepatectomy.7 The key characteristic of the ventral approach is early transection of the cranial portion of the liver, which facilitates accurate transection and maintains an open cutting plane. After achieving a wide surgical plane, the MHV is exposed from the main root toward its peripheral branches. The plane of parenchymal transection is easily modified based on the type of hemihepatectomy. This technique was used in 15 patients between March 2016 and July 2018, of whom 7 underwent right hemihepatectomy and 8 underwent left hemihepatectomy. The median operative time was 240 min (range 180-410), and the intraoperative blood loss was 150mL (range 80-310). The median postoperative hospital stay was 8 days (range 5-14). No major postoperative morbidity or mortality was reported. The ventral approach to the MHV involving exposure of the vein from the main trunk toward its peripheral branches may be an effective and feasible technique during laparoscopic hemihepatectomy.

Unilateral variation in branching pattern of Right Axillary Artery - A Case Report

The Axillary artery is the continuation of the subclavian artery and is a major artery of the upper limb. During the routine dissection for Undergraduate Ayurvedic Medical Students of Sharada Ayurvedic Medical College, Yadgir, Karnataka, India, in the Department of Anatomy, we come across a variation in branching pattern of second and third part of right axillary artery in male cadaver approximately 55 years of age. The first part of axillary artery was found to be normal. In the second part of axillary artery we observed two branches, first one is thoracoacromial artery arose as usual second branch given common trunk which is further divided into lateral thoracic artery and subscapular artery. Even third part of axillary artery gave one common trunk that terminated by bifurcating into Anterior Circumflex Humeral Artery and Posterior Circumflex Humeral Artery.

A cadaveric study on variations in branching pattern of external carotid artery.

Variations in the vascular anatomy of the carotid triangle have been reported in current scientific literature. The carotid arteries, being the major feeding arteries of the head and neck deserve special importance and protection from iatrogenic injury during radiological evaluations and surgical interventions. The present study was carried out over a period of 4 years from 2012–2016 to assess the variant anatomy of external carotid artery. The external carotid artery and its branches were dissected bilaterally in 40 formalin embalmed cadavers. The external carotid artery was traced from its origin to termination and variations in the branching pattern as well as the level of the carotid bifurcation were observed and analysed. A higher carotid bifurcation was observed in 25% cases. The linguofacial trunk was the commonest variation noted in the branching pattern seen in 20% cases. A single case of unilateral thyrolinguofacial trunk was also observed. The external carotid artery gave rise to accessory branches in 7.5% cases namely the superior laryngeal, accessory ascending pharyngeal and masseteric branches. A slender branch to the internal jugular vein was also observed in one case. These findings may provide further insight into the understanding of the vascular anatomy of the carotid triangle to the curious student, the discerning radiologist and the vigilant surgeon to avert complications and help improve overall treatment outcome.

Variant origin and course of the left colic artery: An embryological perspective

The Variations in branching pattern of abdominal arteries are common. These variations are usually due to the changes occurring during the development of vessels. Although the blood supply of the gut is segmental in nature and is genetically regulated, there are other factors determining the final fate of the course and origin of a blood vessel. In this case report the left colic artery was observed to arise anomalously from superior mesenteric artery; 4 cm distal to the origin of superior mesenteric artery from the abdominal aorta –a rare anomaly. The utmost care and proper attention is much needed while doing various diagnostic techniques, operative procedures and angiographic examinations of abdominal organs rather than merely the knowledge of all reported or unreported variations of the abdominal arteries. It should be kept in mind that variations in the abdominal blood vessels are a proof of concept of vascular development.

Study of Branching Pattern of Dorsalis Pedis Artery and its Clinical Significance

Objective: To study the branching Patterns of the Dorsalis pedis artery.Method: The study was conducted in the Department of anatomy, TNMC & BYL Ch. Hospital, Mumbai. Sixty cadaveric lower limbs were dissected below ankle and dorsalis pedis artery was traced to all its branches.Results: We observed 10 different branching patterns of dorsalis pedis artery, some of which were not reported in literature.Conclusion: Dorsalis pedis artery have variations in branching patterns. Knowledge of these variations will help surgeons for planning and better outcome of surgeries involving foot.

A rare bifurcation pattern of the sciatic nerve

Variations in branching patterns of the sciatic nerve are thought to be clinically significant because of the nerve’s extensive distribution area. Here we report a rare and unusual branching pattern of the sciatic nerve which was observed in a male cadaver. Sciatic nerve underwent a high division inside the pelvic cavity, and entered the gluteal region as separate tibial and common fibular nerves. Subsequent distal courses of both nerves into the leg were normal. Knowledge of sciatic nerve variations is useful in treating lower limb neuropathies, such as piriformis syndrome, which tends to be caused by the compression of the sciatic nerve by the piriformis muscle.Keywords: Sciatic nerve bifurcation; sciatic nerve anomalies; piriformis syndrome

A systematic review and meta-analysis of variations in branching patterns of the adult aortic arch

ObjectiveThe aortic arch (AA) is the main conduit of the left side of the heart, providing a blood supply to the head, neck, and upper limbs. As it travels through the thorax, the pattern in which it gives off the branches to supply these structures can vary. Variations of these branching patterns have been studied; however, a study providing a comprehensive incidence of these variations has not yet been conducted. The objective of this study was to perform a meta-analysis of all the studies that report prevalence data on AA variants and to provide incidence data on the most common variants. MethodsA systematic search of online databases including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed for literature describing incidence of AA variations in adults. Studies including prevalence data on adult patients or cadavers were collected and their data analyzed. ResultsA total of 51 articles were included (N = 23,882 arches). Seven of the most common variants were analyzed. The most common variants found included the classic branching pattern, defined as a brachiocephalic trunk, a left common carotid, and a left subclavian artery (80.9%); the bovine arch variant (13.6%); and the left vertebral artery variant (2.8%). Compared by geographic data, bovine arch variants were noted to have a prevalence as high as 26.8% in African populations. ConclusionsAlthough patients who have an AA variant are often asymptomatic, they compose a significant portion of the population of patients and pose a greater risk of hemorrhage and ischemia during surgery in the thorax. Because of the possibility of encountering such variants, it is prudent for surgeons to consider potential variations in planning procedures, especially of an endovascular nature, in the thorax.

Variation in branching pattern of arteries of upper limb – A case report

Variation in branching pattern of arteries of upper limb – A case report

Variations in branching pattern of aortic arch

Variations in branching pattern of aortic arch

Variant branching pattern of dorsalis pedis artery accompanied with anomalous presence of extensor hallucis brevis muscle – A case report

Variant branching pattern of dorsalis pedis artery accompanied with anomalous presence of extensor hallucis brevis muscle – A case report

Variable branching pattern of brachial artery – A cadaveric study

Lymphoepithelioma-like cholangiocarcinoma (LELCC) is a rare variant of intrahepatic cholangiocarcinoma. Epstein-Barr virus (EBV) was reported to be associated with LELCC in approximately 70% of cases by EBV-encoded small non-polyadenylated RNA (EBER) in situ hybridization. In reviewing literature, the treatment experience of advanced LELCC are lacking. In this study, we reported a young female patient diagnosed with locally advanced EBV-associated LELCC with elevated EBV DNA titer and treated with systemic chemotherapy.

A study on variations of branching patterns of median nerve in the carpal tunnel

Abstract Background &amp; aims: The carpal tunnel, located on the palmar surface of the wrist, is a common site of median nerve compression. The median nerve, on passing through the carpal tunnel, divides into lateral and medial branches. The lateral branch then gives off proper palmar digital branches to the thumb and the radial aspect of the index finger, and a recurrent muscular branch to the thenar muscles. The recurrent muscular branch shows different types of variations of the median nerve. Also, there are other variations of the median nerve in the carpal tunnel. These variations greatly influence the symptoms, as well as the treatment of the carpal tunnel syndrome. So, the present work is carried out to study the variations of branching patterns of median nerve in the carpal tunnel. Materials and methods: 40 wrists [20 right and 20 left] from 20 formaldehyde fixed human perinatal fetuses of 34 - 38 weeks of gestation were dissected in the Department of Anatomy, Gauhati Medical College and Hospital, Guwahati. Due ethical clearance was obtained from the Institutional Ethical Committee, Gauhati Medical College and Hospital, Guwahati. Results: In the present study, 24 [66.7%] hands [11 right and 13 left] showed extraligamentous and 12 [33.3%] hands [8 right and 4 left] showed transligamentous variety of thenar branch of median nerve. Also, 4 [10%] hands showed accessory thenar branch of median nerve, all of which took origin within the flexor retinaculum. The comparisons of numbers of variations of thenar branch of median nerve between right and left hands were found to be statistically non significant [P &gt; 0.05]. Conclusion: A detailed knowledge of the median nerve variations in the carpal tunnel is required for successful diagnosis and treatment of the carpal tunnel syndrome and its complications.

Invited commentary

The fact that the knowledge of human anatomy is essential to any clinician is self-evident. Even more detailed anatomic knowledge is needed for surgeons who operate on the knee or on the vasculature of the popliteal fossa; this includes anatomic variations of the popliteal artery. Modern imaging makes planning of surgical interventions much easier, yet in some cases the imaging either cannot be done or may not be sufficient for appropriate surgical planning. In these cases, being prepared to meet an unusual anatomy can save time and minimize surgical trauma. Despite this commonly shared understanding of the importance of an accurate anatomic knowledge, often we rely on old descriptions derived from a few cadaveric dissections. By combining available data from multiple sources, the manuscript published in this issue of the Journal provides contemporary information on the incidence of anatomic variants of the popliteal artery. It is reassuring to know that the prevalence of the most common variant (type I) is 96%, and each of those that are most challenging from the surgical point of view (II-A2 and II-C) have a prevalence of <0.5%. It is also useful to know that the prevalence of specific variants is different in populations of Asia, Europe, and North America, although no direct comparison studies have been done. Apart from the subject matter, this paper is an example of the utilization of contemporary research methodology, such as meta-analysis, in the fields of knowledge that traditionally rely on qualitative research. Hundreds of thousands of imaging studies are done in patients with different diseases and conditions as well as in healthy individuals. Many such studies use standard protocols. Despite the existence of such an enormous volume of anatomic information, few attempts have been made to mine these data and to produce generalizable knowledge. By demonstrating feasibility of such an approach, this paper serves as a catalyst for similar studies answering important anatomic questions, such as ethnic anatomic differences, differences between the cadaveric and imaging studies, and the clinical value of anatomic variants combined with pathologic changes. The evidence-based surgical anatomy of the popliteal artery and the variations in its branching patternsJournal of Vascular SurgeryVol. 65Issue 2PreviewThe goal of our study was to analyze the prevalence of branching pattern variations in the popliteal artery (PA) along with morphometrics of the PA to better address its importance in disease and vascular surgical procedures. Full-Text PDF Open Archive