Huban Thomas

Variant insertion of coracobrachialis muscle in a South Karnataka cadaver

BackgroundThe coracobrachialis is a muscle of arm has been known for its morphological variations. The variation of the coracobrachialis reported in this case is unique and to the best of our knowledge this variation is not reported in south karnataka population.Case presentationDuring routine dissection, we observed an unusual insertion of a coracobrachialis muscle with an accessory slip in the right arm of an old male cadaver. It extended from the superficial fibres of coracobrachialis downwards and medially in front of the median nerve and brachial artery and finally inserted on anteromedial aspect of the medial epicondyle.ConclusionThe existence of abnormal insertion of the coracobrachialis muscle presented in this case should be kept in mind in a patient presenting with high median nerve palsy together with symptoms of brachial artery compression.

Anomalous azygos venous system in a south Indian cadaver: a case report

IntroductionThe posterior thoracic wall, an area drained by the azygos venous system, is a common site for surgical intervention. Since the venous part of the cardiovascular system is subject to most common variation, abnormalities in the azygos venous system are often reported.Case presentationDuring routine dissection classes for undergraduate medical students, we encountered a variation in the azygos venous system in a 65 years old south Indian male cadaver. We observed that there was no accessory azygos vein, and left 4th, 5th, 6th and 7th posterior intercostal veins terminated directly into azygos vein.ConclusionIdentifying these types of variations is important during imaging this region and surgical operations of mediastinum.

Accessory pancreatic duct patterns and their clinical implications

CONTEXT AND OBJECTIVE Accessory pancreatic duct (APD) designed to reduce the pressure of major pancreatic duct by forming a secondary drainage channel. Few studies have mentioned the variant types of accessory ducts and their mode of formation, some of these have a clear clinical significance. Present study is aimed to evaluate the possible variations in the APD and its terminations. MATERIALS AND METHODS Forty formalin fixed adult human pancreas with duodenum in situ specimens were studied by injecting 1% aqueous eosin, followed by piece meal dissection of the head of the pancreas from posterior surface. Formation, tributaries, relations, and the termination of the accessory pancreatic duct were noted and photographed. RESULTS Accessory ducts revealed 50% belonged to long type, 22.5% were of short and ansa pancreatica type each, and embryonic type of duct pattern was seen in 5% specimens. 75% of long type ducts showed positive patency with eosin dye, followed by ansa type (44.4%), and least patency was found in short type (22.2%). With regard to the patency of the accessory pancreatic ducts towards their termination, we found 52.5% of the accessory ducts and 5% of the embryonic type pancreatic ducts were patent and in 42.5% of the specimen the ducts were obliterated. In 85% of specimens the minor duodenal papillae was anterosuperior to the major papilla and superior to the major papillae in 10% of the cases, and in 5% minor papillae was absent. The average distance between the two papillae was 2.35 cm. CONCLUSION The knowledge of the complex anatomical relations of the gland with its duct, duodenum and bile ducts are essential for the surgeons and sinologists to plan and perform both the diagnostic as well as therapeutic procedures effectively.

Left-Sided Persistent Superior Vena Cava with Superior Hemiazygos Arch.

Persistent Left-side Superior Vena Cava (PLSVC) is the congenital central venous anomaly draining into the right atrium in 82-90% of cases via coronary sinus produce no haemodynamically significant consequences. In few cases it may drain into the left atrium directly or through the pulmonary veins resulting in right to left shunt. During routine undergraduate dissection, we found a PLSVC formed by the union of left subclavian and left internal jugular veins behind the left sternoclavicular joint was terminated into the right atrium through a larger coronary sinus ostium. Before its termination, PLSVC received a left hemiazygos vein formed by the continuation of the superior and inferior hemiazygos veins. A larger but thin communicating vein was noted between the right superior vena cava and PLSVC. Prior knowledge about such variations is essential in all the intervention procedures on right atrium through the left subclavian approach and also like in our case, the larger coronary sinus ostium if found during transthoracic echocardiography should be considered as an indication for the diagnosis of PLSVC.