Cardiovascular system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Figure 9.51a shows the arterial supply to the lower limbs. The abdominal aorta bifurcates into the right and left common iliac arteries, usually at the level of L4. Each common iliac artery further divides into the internal iliac artery, which supplies the pelvis, and the external iliac artery, which continues down the leg to become the common femoral artery (CFA) once it crosses below the inguinal ligament. A few centimetres below the inguinal ligament the CFA divides into the profunda femoris (PFA) and superficial femoral (SFA) arteries. The PFA supplies the muscles of the thigh and the SFA continues to the knee. Just above the knee (at the adductor hiatus), SFA becomes the popliteal artery. Below the knee this artery trifurcates into the anterior tibial (AT), posterior tibial (PT) and peroneal arteries. The AT continues towards the foot to become the dorsalis pedis artery at the ankle, which supplies the dorsal aspect of the foot. The PT and peroneal often have an initial short common trunk (tibio-peroneal trunk). The PT gives rise to the medial and lateral plantar arteries that supply the plantar aspect of the foot. The peroneal artery supplies the lateral aspect of the lower leg. There is a corresponding system of veins draining blood back into the inferior vena cava and then to the heart (Fig. 9.51b).
Normal Fetal Anatomy
Asim Kurjak in CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
The fetal aorta is easily recognized on longitudinal scans, and its different portions (aortic root with brachycephalic vessels, the descending aorta and its bifurcation into the iliac vessels) can be identified (Figures 36 and 37). The inferior vena cava can be seen as a large vessel entering the right atrium just above the confluence of the hepatic veins (Figure 38). The lungs appear as two moderately and homogeneously echogenic areas on either side of the heart. In longitudinal section, the diaphragm can be recognized between the lungs and liver as a relatively transonic sliver moving during respiratory excursions (Figure 39). Lung echogenicity increases after 35 to 36 weeks, approaching that of the liver. The significance of increased lung echogenicity for ultrasonic estimation of fetal lung maturity is still being investigated26 (Figure 39).
Congenital Heart Disease A Clinician's Perspective
P. Chopra, R. Ray, A. Saxena in Illustrated Textbook of Cardiovascular Pathology, 2013
Umbilical vessels act as connecting links between the fetus and placenta. Umbilical arteries carry blood from the fetus to the placenta and umbilical vein which has a higher P02 in turn takes blood from placenta to the fetus. The umbilical venous blood reaches the inferior vena cava partly through the hepatic circulation and partly through ductus venosus bypassing the liver. Therefore, inferior vena cava has a highly oxygenated blood. About one-third of this blood is directed into left atrium through patent foramen ovale due to the particular relationship of inferior vena cava opening to the foramen ovale. The rest of caval blood mixes with the inflow from superior vena cava and enters the right ventricle and then the pulmonary artery. The oxygenated blood which reaches left atrium from inferior vena cava is further passed into left ventricle and then pumped into ascending aorta, thereby, giving supply to the heart and brain. On the other hand, 90% of the mixed blood from pulmonary artery is shunted through patent ductus arteriosus (PDA) into the descending aorta. The blood going to the descending aorta supplies the rest of the fetus and umbilical arteries. Very small amount of blood
Variations in the vascular and biliary structures of the liver: a comprehensive anatomical study
Published in Acta Chirurgica Belgica, 2018
Burak Veli Ülger, Eyüp Savaş Hatipoğlu, Özgür Ertuğrul, Mehmet Cudi Tuncer, Cihan Akgül Özmen, Mesut Gül
Images of the proper hepatic artery, portal hepatic vein, and other hepatic veins can be obtained via MDCT; MRCP yields detailed images of the bile ducts, allowing for easy detection of variations. The proper hepatic artery exhibited the classic anatomy in 54% of our cases; the most common variations were Michels type 5 (13%) and Michels type 2 (11%). In terms of the hepatic portal vein, type 1 (the classic variation in Covey et al. [24]) was detected in 76% of the cases; the next most common variations were type 2 (9%) and type 3 (8.5%). In terms of the hepatic veins, the left and intermediate veins formed a single root in 64% of the patients and drained into the inferior vena cava. In all other patients (72; 36%), the left, intermediate, and right hepatic veins drained separately into the inferior vena cava. In terms of the bile duct, 51.5% of cases exhibited the type A variation (the classic anatomy of the Couinaud classification); the next most common variations were type C1 (15%) and type B (12%). Thus, diversity in the bile duct was greater in our patients than in other studies. It is essential to identify anatomical variations prior to intervention; our data will assist in this regard.
A case of a borderline adrenal oncocytoma in a 62-year old female
Published in Acta Chirurgica Belgica, 2022
Olivia Behaeghe, Bernard Geurde, Jean-Luc Jourdan, Céline Bodson, Benoît Seydel, Daniel Lacremans
The patient undergoes surgery for the resection of the tumor. Given the size and the uncertainty of the aspect, we opt for an open surgery under general anaesthesia. She is placed in dorsal decubitus with a 30° left tilt. A right subcostal incision is made to access the abdominal cavity. The superior and inferior right hepatic triangular ligaments are divided and the surrenal mass is visualized. The aspect of the mass is inflammatory, fixed and adherent to the adjacent structures. The liver is reclined up to the inferior vena cava. The dissection is carried out in a circular manner around the tumor. We free the superior part of the kidney while controlling the diaphragmatic vessels. The median adrenal vein is visualized and sutured on the lateral margin of the vena cava for haemostatic control. The arterial vascularization is controlled with a clip. The mass is mobilized anteriorly and is progressively detached from the kidney and the right renal vein. There is a small rim of normal surrenal tissue at the lateral right border of the vena cava that needs a separate resection. A small retrocaval cellulo-fatty blade is also resected in a second time. A drain is placed in the tumorectomy cavity.
Interatrial shunts: technical approaches to percutaneous closure
Published in Expert Review of Medical Devices, 2018
Gianluca Rigatelli, Marco Zuin, Nguyen Tuong Nghia
From an embryological point of view, the EV is derivative of the right sinus venosus valve. Morphologically, it has a semicircular shape and is facing the anterior-inferior aspect of the inferior vena cava. The CN represents a very huge multi-perforated Eustachian valve with a network-like appearance and it has been found in 1.3% to 4% of autopsies. The EV and CN, guarding the anterior-inferior aspect of the inferior vena cava, has a crucial role in deflecting the blood flow through the foramen ovale during the fetal life, predisposing to paradoxical embolism [33]. Large PFO and prominent EV or right atrial (RA) filamentous strands were found more frequently in patients with septal aneurysm compared with those without (37.7% vs. 10.9%, p < 0.001 and 59.4% vs. 43.1%, p = 0.02) [34]. As previously reported by TEE studies, an EV is present in 48% of patients with cryptogenic stroke [34] and a large CN is associated with PFO in 83% of cases [33]. TEE and ICE seem to be the most sensitive imaging tools for detecting these embryonicremnants. Indeed, ICE has been found to be extremely accurate in detecting both entities, which resulted in independent predictors of large shunt and recurrent paradoxical embolism. From a technical point of view, the presence of such structures should be taken in account during transcatheter closure, representing potential technical difficulties.