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Lymphatic anatomy: lymphatics of the vulva
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Anca Chelariu-Raicu, Robert L. Coleman
The landmarks and topographic anatomy of the groin are illustrated in Figure 3.3. The same keratinizing squamous epithelium that covers the vulva covers the groin. Deep to the skin is the subcutaneous tissue, which is divided by the superficial, or Camper’s, fascia. Dorsal to this layer is fatty tissue containing the superficial inguinal nodes and the superficial vasculature, such as the superficial external circumflex vessels, the super-ficial inferior epigastric vessels, and the superficial external pudendal vessels. Removal of this layer reveals the deep femoral fascia, which is continuous laterally with the fascia lata of the thigh and medially with the fascia of the adductor longus muscle, and which is coplanar with the inferior fascia of the urogenital diaphragm. The fossa ovalis is demarcated by the falciform, or Hey’s, ligament and is perforated by the great saphenous vein and other small vessels. As described later, the perforate covering over the fossa is most aptly termed the crib-riform lamina. Below the femoral fascia lies the femoral vessels and nerve, along with the deep musculature of the groin. The femoral or deep inguinal nodes are located along the fem-oral vein and usually within the fossa ovalis. The most superior node is commonly referred to as the node of Rosenmüller or Cloquet.
Cardiology
Published in Paul Bentley, Ben Lovell, Memorizing Medicine, 2019
PATH: Location: L atrium, in fossa ovalis – 90% SolitaryGelatinous, friable, attached by pedicle to fossa ovalis
Trans-septal cardiac catheterisation
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Other important structures related to the fossa ovalis include the aortic knuckle (torus aorticus), which lies antero-superiorly, and the coronary sinus, which lies antero-inferiorly (Figure 30.1a). The Eustachian valve, which lies on the anterior rim of the inferior vena cava (IVC), helps direct pre-natal blood flow from the IVC towards the foramen ovale and away from the right ventricle. It may remain prominent into adult life. Its size and shape are variable, with some persisting as mobile structures that project into the RA.
Posture Dependent Hypoxia Following Lobectomy: The Achilles Tendon of the Lung Surgeon?
Published in Journal of Investigative Surgery, 2022
Athanassios Krassas, Aikaterini Tzifa, Stavroula Boulia, Kosmas Iliadis
Another explanation for the POS is the post-operative relocation of the AS. This is the result of post-resection mediastinal shift that produces distortion and stretching of the septum while the Inferior Vena Cava (IVC) remains in place and no interatrial pressure gradient is observed. In normal individuals, the blood stream of the SVC is draining downward to the anterior part of the RA while the IVC is emptying in the posterior part. The repositioning of the AS favors the blood flow to pass via the atrial defect. In the upright position, the stretching exacerbates due to gravity that widens the interatrial communication causing a right-to-left shunt even in cases where the intracardiac pressures remain normal [16, 17]. However, recent works suggest that the mobility of the fossa ovalis membrane might favor and enhance the flow toward the foramen ovale [6] especially during the mid-systole, when a pronounced motion of the AS toward the left atrium occurs [18].
A giant left atrial myxoma causing mitral valve pseudostenosis – a mimicker
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Basel Abdelazeem, Hafiz Khan, Hameem Changezi, Ahmad Munir
The echocardiogram is the diagnostic modality of choice to make the diagnosis; the presence of mobile mass with a stalk arising from the endocardial surface of the fossa ovalis is considered diagnostic without further imaging. In our patient, a giant 5.5 × 4.5 cm mobile density mas was attached to the interatrial septum with a thin stalk. The differentiation between CM and vascular tumors or thrombi can be done with contrast echocardiography perfusion or quantitative real-time perfusion imaging echocardiography [8]. Cardiac magnetic resonance is helpful if CM cannot be visualized on echocardiography, and it is an important tool to identify the mass shape, density, and tissue signal intensity [8]. Definitive diagnosis can usually be made after surgical resection using macroscopic and histopathology.
The Revolution in Heart Valve Therapy: Focus on Novel Imaging Techniques in Intra-Procedural Guidance
Published in Structural Heart, 2021
Michaela M. Hell, Felix Kreidel, Martin Geyer, Tobias F. Ruf, Alexander R. Tamm, Jaqueline G. da Rocha e Silva, Thomas Münzel, Ralph Stephan von Bardeleben
Identifying the optimal transseptal puncture site is the first crucial part for many structural heart interventions and, in particular, transvenous mitral valve interventions (repair, replacement, and PVL closure) as its height and orientation majorly impacts the further procedure by determining the angle for approaching the valvular coaptation plane. This step is routinely guided by biplane TEE to identify the anterior-posterior orientation (mid-esophageal short-axis view) and the superior-inferior orientation (bi-caval view) as well as to determine the correct height of the puncture site in relation to the mitral valve plane (four-chamber view) (Figure 2a).18 Given the individual anatomy and orientation of the fossa ovalis, the standard fluoroscopic angulations can only approximate its position. By merging echocardiographic and angiographic images, the fossa ovalis is visualized on the fluoroscopic screen and the angulation can be adjusted step-wise to achieve the correct perspective (Figure 2b). Echocardiographic-fluoroscopic fusion imaging has been shown to be a safe approach to guide transseptal puncture and even reduce procedural time.18–21 Alternatively, ICE provides direct visualization of the interatrial septum and has been shown to be a valuable tool to guide a safe transseptal puncture.22