Swamy S Ravindra

Additional circular intercostal space created by bifurcation of the left 3rd rib and its costal cartilage: a case report

IntroductionIn the thorax there are normally 11 pairs of intercostal spaces: the spaces between adjacent ribs. The intercostal spaces contain intercostal muscles, intercostal nerves and vessels.Case presentationDuring a routine dissection for undergraduate medical students, we observed a variation involving the left 3rd rib and 3rd costal cartilage in the cadaver of a man of Indian ethnicity aged about 65 years. The left 3rd rib and its costal cartilage were bifurcated at their costochondral junction enclosing a small circular additional intercostal space. Muscle tissue covered by deep fascia was present in this circular intercostal space. The muscle in the circular intercostal space received its nerve supply from a branch of the 2nd intercostal nerve.ConclusionsKnowledge of such variations is helpful to surgeons operating on the anterior thoracic wall involving ribs and intercostal spaces. Knowing the possibility of the presence of an additional space between normal intercostal spaces can guide a surgeon through to a successful surgery.

Absence of the external jugular vein and an abnormal drainage pattern in the veins of the neck

Introduction: The knowledge of variations of veins of head and neck is of clinical importance. The aim of this report was to discuss the absence of the external jugular vein (EJV) and an abnormal drainage pattern in the veins of the neck. Case report: During routine dissection of the head and neck region, a unilateral variation in the formation and drainage pattern of veins was seen on the left side of an approximately 60-year-old male cadaver. The anterior division of the retromandibular vein joined the facial vein to form the common facial vein, which drained into the anterior jugular vein instead of the internal jugular vein. The posterior division of the retromandibular vein drained directly into the internal jugular vein. The retromandibular vein was unusually wide in calibre, and there was total absence of EJV. Since the EJV is frequently used for central venous cannulation as well as often examined by clinicians to assess the venous pressure in the right atrium, its absence may mislead the clinicians during these approaches. So the knowledge of variations in veins of head and neck is important for surgeons during head and neck surgery as well as for radiologists during catheterization and for clinicians in general. Conclusion: Absence of EJV and the abnormal pattern of drainage of veins in the neck reported here are very rare. Awareness of these venous variations is vital for the surgeons to avoid any intraoperative trial or error during surgical procedures and to prevent unnecessary bleeding.

A unique case of bifid left testicular artery having its anomalous high origin from renal artery

The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed behind the left renal vein, passed between the left testicular vein and left ureter and at the lower pole of the left kidney, this bifid testicular artery joined to form a single testicular artery which thereafter presented a normal course. Anatomy of the testicular artery has been studied in detail because of its importance in testicular physiology, as well as its significance in testicular and renal surgery. This vascular variation shows a major significance in renal surgery, partial or total nephrectomy, and renal transplant. In addition, this anatomical variation enhances the importance of arteriography or the Doppler ultrasound examination of the renal hilum before surgeries.

Presence of an accessory spleen in the gastrosplenic ligament: Its histological observation and clinical consequences

Accessory or supernumerary spleens are congenital in occurrence. Its presence may result in differential diagnosis or exhibit continued symptoms after therapeutic splenectomy. We report here a case of accessory spleen (AS), which was remarkably larger in size was found within the gastro-splenic ligament, adherent to its anterior layer. It received an independent vascular supply from splenic vessels supplying the main spleen (MS). Its histological architecture was in close resemblance to that of MS, but with the deficiency of white pulp. Failure to remove AS during main splenectomy done for pathological conditions may result in failure of resolving the condition due to which the pathological condition persists. Occurrence of ASs may also be confused for enlarged lymph nodes or neoplastic growth in the tail of pancreas, gastrointestinal tract and adrenal glands.

Lateral pouch appendix associated with retroperitoneal terminal part of the ileum: a potential diagnostic and surgical challenge

Knowledge of development and various possible positions of the appendix is important in understanding the pathophysiology of appendicitis. In the present case, we report on a lateral pouch type of appendix in a formalin-embalmed male cadaver. The appendix was found to be situated in a space between the caecum and the lateral abdominal wall. A short band of peritoneum extended from the right iliac fossa to the base of the appendix. The terminal part of the ileum was retroperitoneal and it was vertically situated in the right iliac fossa. Both the ileocaecal junction and the base of the appendix were located at the posterolateral wall of the caecum. The mesoappendix was unusual in position, and it extended from the appendix to the anterolateral wall of the caecum and commencement of the ascending colon. Documentation of rare anatomical variants of the appendix may hold significant clinical importance in diagnosis as well as surgical treatment of appendicitis.

A Rare Variation in the Origin and Course of the Artery of Penis

Vascular variations of the penis are very rare. Awareness of its variations is of utmost importance to the urologists and radiologist dealing with the reconstruction or transplants of penis, erectile dysfunctions, and priapism. We report an extremely rare variation of the artery of the penis and discuss its clinical importance. The artery of the penis arose from a common arterial trunk from the left internal iliac artery. The common trunk also gave origin to the obturator and inferior vesical arteries. The artery of the penis coursed forward in the pelvis above the pelvic diaphragm and divided into deep and dorsal arteries of the penis just below the pubic symphysis. The internal pudendal artery was small and supplied the anal canal and musculature of the perineum. It also gave an artery to the bulb of the penis.

Eight prehilar branches of the right renal artery.

Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vessels at the hilum of the kidney. During routine dissections, a variation in the branching pattern of the right renal artery was noted in an adult male cadaver. The right renal artery divided into upper and lower divisions 6cm away from the hilum of the kidney. The upper division gave 4 branches, and the lower division gave two branches. These two branches further bifurcated and gave 2 branches each. Thus, there were 8 prehilar branches of renal artery. The multiple prehilar branches led to a congested atmosphere at the hilum of the kidney. This arterial congestion might result in hindering the blood flow at the renal hilum. Apart from this, it might cause difficulties in diagnostic and therapeutic invasive procedures. Knowledge of this variation is of importance to radiologists and urologists in particular.