High Prevalence of Anatomical Variations and Anomalies of the Coronary Arteries Detected by CT Angiography in Symptomatic Patients

Objective:Coronary artery anatomical variations and anomalies are an important topic due to their potential clinical manifestations.This study aims to investigate the prevalence of coronary artery anatomical variations and anomalies in symptomatic patients with coronary computed tomography angiography(CCTA).Methods:This is a retrospective study that included all symptomatic patients who had CCTA in a tertiary care hospital in Saudi Arabia during a period of seven years.Results:The total number of included patients was 507(60%males)with a mean age of 57.4 years.Approximately 41%had luminal stenoses,averaging 49.7%.The total num-ber of patients with coronary anatomical variations(CAV)and coronary artery anomalies(CAA)was 217(43%).CAV prevalence was 26%,which included 14%non-right coronary dominance,5%short left main coronary artery(LMCA),and 7%division variations(trifurcation and quadrifurcarion)of the LMCA.The prevalence of CAA was 29%,which included 5%origin anomalies,22%myocardial bridge,and 2%course anomalies.Conclusions:A high prevalence of coronary artery anatomic variations and anomalies in symptomatic patients is reported in this study.Systematic reviews,meta-analyses,reporting guidelines,and unified definitions and classifications of cor-onary variations and anomalies are lacking in the literature,presenting potential opportunities for future research and publications.

Clinical study of arterial anatomic variations for transradial coronary procedure in Chinese population

Background The radial artery is currently regarded as a useful approach for coronary intervention procedures. Adequate anatomical information of the radial artery should be helpful in performing transradial coronary procedures. Few data about the Chinese population have been obtained in this field. Therefore, we tried to evaluate the incidence and clinical significance of anomalous patterns, and their influence on the intervention procedure. Methods In an estimated sample of 3000 cases, radial artery and subclavical artery angiography were performed after insertion of the sheath and coronary angiography （CA）. The evaluable data including branch anomaly, tortuosity of the radial artery and procedural characteristics were analyzed. The procedure success was defined as CA or percutaneous coronary intervention （PCI） completed with the initial radial artery approach without changing to other routes. Results In this study, 1897 cases of CA was undertaken and 1103 cases of CA combined with PCI were performed. The success rate of transradial intervention （TRI） was 96.6% （2899/3000）. The approach in 44 cases was changed to the contralateral radial artery and 57 cases were changed to the brachial artery or femoral artery due to failure with the initial radial artery approach. The angiography of the upper limb artery was performed in all cases. Anatomic variations of upper limb arteries were noted in 610 patients （20.3%）, which included tortuous configurations of the radial artery （5.0%）, hypoplasias （2.2%）, radioulnar loop （1.1%）, abnormal origin of the radial artery （7.7%）, stenosis of radial artery （1.4%）, a tortuous configuration of the brachial artery （0.9%）, a tortuous configurations of the subclavian artery （1.9%）, lusoria subclavian artery （0.1%）, and subclavian artery occlusion （0.03%）. The procedural success rate in the normal population was higher than in the variation group （97.6% vs 93.0%, P 〈0.001）. In addition, other procedural outcomes and incidence of complications except radial artery occlusion were also significantly superior to variation group. Conclusions Anatomic variations of the radial artery were common, making up an important limitation in the trans- radial approach. Selection of appropriate instruments and understanding some tips and tricks were helpful to overcome the obstacles and effectively reduce the learning curve.

Anatomical variations of the cystic duct:Two case reports

Anatomical variations of the cystic duct often occur and may be encountered during cholecystectomy. Knowledge of the variable anatomy of the cystic duct and cysticohepatic junction is important to avoid significant ductal injury in biliary surgery. Here, we present two unusual cases with an anomalous cystic duct, namely, low lateral insertion and narrow-winding of the cystic duct. The first case was a 64-year-old man with cholelithiasis and chronic cholecystitis. During surgery, the entrance of the cystic duct was misidentified as being short and leading into the right hepatic duct. Further exploration showed multiple calculi in the right and common hepatic ducts. Cholecystectomy was completed, followed by T-tube drainage of the common and right hepatic ducts. Postoperative T-tube cholangiography demonstrated that the two T tubes were respectively located in the cystic and common hepatic duct. Six weeks later, the retained stones in the distal choledochus were extracted by cholangioscopy through the sinus tract of the T-tube. The second case was a 41-year-old woman, in which, preoperative endoscopic retrograde cholangiopancreatography (ERCP) revealed a long cystic duct, with a narrow and curved-in lumen. The patient underwent open cholecystectomy. Both patients were cured. The authors propose that preoperative ERCP or magnetic resonance cholangiopancreatography (MRCP), and intraoperative cholangiography or cholangioscopy constitute a useful and safe procedure for determining anatomical variations of the cystic duct.

Ultrasonographic identification of lateral femoral cutaneous nerve anatomical variation in persistent meralgia paresthetica:A case report

BACKGROUND Meralgia paresthetica(MP)is an entrapment mononeuropathy of the lateral femoral cutaneous nerve(LFCN).Although structural abnormalities in nerve tissues can be confirmed using ultrasonography,this is not routinely performed.CASE SUMMARY Herein,we present the case of a 52-year-old woman who developed MP after laparoscopic gynecological surgery.The patient was referred to our clinic from an obstetrics and gynecology clinic with symptoms of numbness and a tingling sensation in the left anterolateral thigh,which developed after surgery performed 5 mo earlier.Tests were performed to assess the disease status and determine the underlying causes.Ultrasonographic examination revealed an anatomical variation,where the left LFCN was entrapped within the inguinal ligament.This case suggests that performing ultrasonographic examination before and after surgery in the lithotomy position could help prevent MP.CONCLUSION This case demonstrates the value of ultrasonography in detecting anatomical variation and diagnosing persistent MP.Ultrasonography should be considered an adjunct to electromyography for optimal MP management.Further,this case would help other clinicians determine patient prognosis and decide on targeted treatment strategies.

Multidetector computer tomography and magnetic resonance imaging of double superior mesenteric veins:A case report

BACKGROUND This study aimed to describe the findings of double superior mesenteric veins(SMVs),a rare anatomical variation,on multidetector computer tomography(MDCT)and magnetic resonance imaging(MRI)images.CASE SUMMARY We describe the case of a 34-year-old male,who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis.MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein(SMV),the double SMVs.CONCLUSION The double SMVs are a congenital abnormality without potential clinical manifestation.Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.

Commentary on:“Evaluation of variations in sinonasal region with computed tomography”

This letter is a commentary on the article titled "Evaluation of variations in sinonasal region with computed tomography", published in the January 2016 issue of World Journal of Radiology. The authors definition of the secondary middle turbinate is incorrect. The authors stated that the secondary middle turbinate is an accessory turbinate that is seen between the superior and middle turbinates. It should originate from the middle meatus posterosuperior to the ethmoid infundibulum.

Analysis of the Influence of Sound Source Position and Electrode Placement on the Stimulation Pattern of the Cochlear Implant under Noise Conditions: Optimization of Auditory Perceptual Effects

Background: Cochlear implants (CI) are widely used to restore hearing in people with severe to profound hearing loss. However, optimizing CI performance, especially in difficult listening environments with background noise, remains a major challenge. Understanding the influence of factors such as sound source position and electrode placement on CI stimulation patterns is critical to improving auditory perception. Methods: In this study, an analysis was conducted to investigate the influence of sound source position and electrode placement on CI stimulation patterns under noisy conditions. For this purpose, a special measurement setup with a CI speech processor-microphone test box was used to simulate realistic listening scenarios and measure CI performance. Results: The results show that the effectiveness of CI noise reduction systems is influenced by factors such as the position of the sound source and electrode placement. In particular, the beamforming ultra zoom mode showed significantly better noise reduction than the omnidirectional mode, especially under real listening conditions. Furthermore, differences in electrode responses indicate individual variability in the CI user experience, highlighting the importance of personalized fitting algorithms. Conclusions: The results demonstrate the importance of considering environmental factors and individual differences when optimizing CI performance. Future research efforts should focus on the development of personalized fitting algorithms and the exploration of innovative strategies, such as the integration of artificial intelligence, to improve CI functionality in different listening environments. This study contributes to our understanding of CI stimulation patterns and lays the foundation for improving auditory perception in CI users.

Living donor liver hilar variations: surgical approaches and implications

BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

Evaluation of variations in sinonasal region with computed tomography

AIM: To investigate the frequency of anatomical variations in sinonasal region and association of these variations with mucosal diseases. METHODS: The study included 400 cases(191 female and 209 male) who were considered to have preliminary diagnoses of sinonasal pathology and who had paranasal sinus computed tomography(CT) examination in axial plane. Reformatted CT images were studied in all planes.RESULTS: Age range of the patients was 20-83(mean 40.26 ± 14.85). Most commonly detected anatomical variation was Agger nasi cell(74.8%). There was a significant association between clinoid process pneumatization and protrusion of internal carotid arteries and optic nerves into sphenoid sinus(P < 0.001). Besides,the relationships between pterygoid process pneumatization and protrusion of vidian nerve into sphenoid sinus,and between pneumatization of large sphenoid wing and protrusion of maxillary nerves into sphenoid sinus were also significant(P < 0.001). Uncinate bulla and giant ethmoid bulla were found to be significantly associated with sinonasal mucosal diseases(P = 0.004 and P = 0.002,respectively).CONCLUSION: Sinonasal region has a great number of variations,and some of them have been determined to be associated with sinonasal mucosal disease. It is necessary to know that some of these variations are associated with protrusion of significant structures such as carotid artery or optic nerve into the sinus and care should be observed in surgeries on patients carrying these variations.

Variations in the bifurcation level of the abdominal aorta, formation level of the inferior vena cava, and insertion level of the left renal vein into the inferior vena cava and their clinical importance in laparoscopic surgery

Objective: It is important to minimize the risk of major vascular injury during pneumoperitoneumestablishment in laparoscopic surgeries for patients with unusual variations in the levels of theabdominal aorta, the inferior vena cava (IVC), and the left renal vein, which will decrease the morbidityand mortality. The study aims to assess the variations regarding the bifurcation level of the abdominalaorta, formation level of the IVC, and insertion level of the left renal vein into the IVC.Methods: This retrospective study was conducted on 100 patients (50 males and 50 females) referred tothe Department of Radiology, Jordan University Hospital for abdomino-pelvic CT with intra-venouscontrast from January 2018 to December 2019. The three vessels were determined on the axial plane,the coronal plane, and the midsagittal plane. The central vertebral body height as well as the distance ofthe level of the point of interest to the upper end plate of the vertebrae were measured. Afterwards, theresults were classified into the following categories, upper end plate, lower end plate, intervertebral disc,upper half, and lower half of the vertebra.Results: The aortic bifurcation was mainly found at the level of the L4 vertebral body (65, 65%). In theremaining cases, the bifurcation was found to be variably located spanning from L3 in 11 (11%) cases to3 (3%) cases at L5. As for the iliocaval junction, the most common site was also at the level of L4 with41 (41%) cases followed by 39 (39%) cases at the level of L5, and 20 (20%) cases at the intervertebral discof L4/L5. The left renal vein most commonly joined the IVC at the level of L1 with 62 (62%) cases followedby 20 (20%) cases at the intervertebral disc T12/L1. There was wide variation in its entry to the IVCspanning from 4 (4%) cases at T12/L1 to 1 (1%) case at L4.Conclusion: The anatomical variation of the major vessels can be found in the normal population.Therefore, sufficient investigation of the anatomical position of these vessels is essential for patientsbefore laparoscopic surgery.

Choledocholithiasis caused by anatomical variation of cystic duct: A case report

Laparoscopic cholecystectomy(LC)has gradually become the first choice for the treatment of cholecystolithiasis in recent years.Iatrogenic bile duct injury(IBDI)is an important clinical problem in LC.The anatomical variation of the cystic duct increases the probability of IBDI and the difficulty of operation.We present a case of a 44-year-old male with a anatomical variation of the cystic duct complicated with cholecystolithiasis and choledocholithiasis,who successfully underwent choledocholithotomy,choledochoscopic exploration and T-tube drainage surgery.The patient recovered well and was discharged home on postoperative day 10.The T-tube was removed at 1 month postoperatively after cholangiography examination of no choledocholithiasis left.

Supernumerary brachioradialis-Anatomical variation with magnetic resonance imaging findings:A case report

BACKGROUND In this single case report study,we describe an anatomical variance of a brachioradialis muscle with two muscle bellies and two tendons with their common insertion on the suprastyloid crest of a distal radius.CASE SUMMARY After a self-mutilating forearm injury of a borderline personality patient,we observed the anatomical variation of brachioradialis tendon.After tendon repair and aftercare the muscle function recovered completely.Five months after surgery the forearm magnetic resonance imaging was done revealing a supernumerary brachioradialis muscle.CONCLUSION Anatomical variations of forearm muscles and tendons are not rare.The treating surgeons should be aware of their existence and anatomical relationships.

An Aberrant Origin of the Right Hepatic Artery: A Rare Anatomic Variation. And Its Clinical Application

The right hepatic artery is an important arterial supply to right lobe of the liver. And the knowledge of the normal anatomy and anatomical variations of the right hepatic artery is essential to perfume, and will minimize morbidity, and also help to decrease the number of complications of hepatobiliary surgery. This study was conducted on eleven human cadavers, which were obtained from the routine autopsies at the dissection room of the Anatomy Department. During dissection of the eleven cadaveric livers, we found a case with an ex-ceptional anatomic variation;a replaced right hepatic artery (RRHA) coming off the superior mesenteric artery (SMA), directly to the hepatic right lobe passing through the Calot’s triangle, crossing behind the common hepatic duct (CHD). Our objective is to draw much attention to this particularly anatomic variation of the origin of the RRHA as well as its clinical importance in order to ensure that no damage will be made during gastrointestinal and hepatobiliary surgery.

Anatomic Variation in Palatal Root of Maxillary Second Molar: Endodontic Management

The aim of the present clinical case report is to describe the singular root canal anatomy and endodontic management of a maxillary second molar with two palatal roots and two separate canal orifices. A 60 years-old female Hispanic/Latino patient attended the Endodontic Department at University of Buenos Aires School of Dentistry with acute pain in her maxillary left second molar. Clinical radiographs examination revealed unusual root morphology. Cleaning and shaping were completed with 5.25% NaOCl irrigation, 15% EDTA solution and hand/rotary instruments. Filling was performed with gutta-percha points and resin-based sealer. After one year follow-up periapical radiographs and CBCT images showed healing in the area and patient was asymptomatic.

Anatomic Dissection of the Femoral Vein at the Bamako Anatomy Laboratory

Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadavers were dissected and photographed. Results: The diameter of the superficial, deep and common femoral veins was respectively 8.75 mm;7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long. At the level of the superficial vein, the modal disposition was noted in 79.17%;as anatomical variations, it was split in 2 cases, the presence of a collateral canal in 1 case and in 2, and it received a quadricipital muscle vein. At the level of the deep femoral vein, the modal disposition was noted in 16.67%, and the anatomical variations were noted in 83.33% where it received no affluent in the femoral trine. The modal disposition was noted in 91.67% at the level of the mode of birth of the common femoral vein, in 16.67% at the level of its tributaries. The anatomical variations were noted in 8.33% in the mode of birth of the femoral vein, in 83.33% in which the common femoral vein received, in addition to the large saphenous vein, other tributaries, the most frequent of which were the quadricipital veins and the circumflex femoral veins. Conclusion: The diameter of the femoral veins is important. The main tributaries of the common femoral vein are GVS, VQ and circumflex femoral veins. The femoral variations are numerous and important to know to avoid a possible misdiagnosis in case of their thrombosis.

MULTIDETECTOR CT STUDY OF ANATOMICAL VARIANTS OF ETHMOID SINUS

Objective To evaluate the significance of multidetector CT 3D reconstruction technique inshowing anatomy of ethmoid sinus, at the same time, anatomic variations of ethmoid sinus and its clinical significance were also discussed. Methods 250 cases of ethmoid sinuses were scanned transversally by multidetector scaner, coronal and sagittal views were reconstructed. Results Coronal and sagittal views were good enough to make diagnosis. 5 kinds of common ethmoid sinus variations were seen, including pneumatization of ethmoid bulla (56. 5% ) , Onodi air cell(26% ) , Haller cell(6. 5% ) ,low ethmoid foveolas(4. 3% )and over intromigratiny lamella papyracea (6. 5% ). Conclusion The coronal and other special views of ethmoid sinus are showed clearly by 3D reconstruction which can provide detailed image informations for functional endoscopic sinus surgery.

鼻窦CT在内镜鼻窦手术前前颅底解剖变异评估中的临床价值

目的探究鼻窦CT在内镜鼻窦手术前前颅底解剖变异评估中的临床价值。方法对北京京煤集团总医院2019年8月~2022年8月间收治的鼻内镜手术患者150例(300侧)进行回顾性分析,患者术前均行鼻窦CT扫描,测量筛板和筛孔中心之间外侧板的长度(LLCP长度)并进行Keros分型,测量筛前动脉(anterior ethmoidal artery,AEA)至颅底的距离并进行分型,采用Spearman相关性分析AEA悬空与Keros分型的相关性,测量LLCP与筛板向外侧的延长线所形成的夹角(LLCP-CP角),根据LLCP-CP角进行医源性损伤风险分型(Gera分型),观察钩突上附着点(superior attachment of uncinate process,SAUP)的解剖位置并进行分型,分析SAUP分型与钩突内引流、外引流以及额窦炎发生率的关系。结果150例患者嗅凹深度(5.82±1.16)mm,AEA至颅底距离(3.78±1.09)mm,AEA至额嘴长度(13.97±2.45)mm,LLCP长度0.5~13(5.60±1.24)mm,LLCP-CP角69.22°±12.85°;AEA位置I型64例(42.67%),Ⅱ型28例(18.67%),Ⅲ型58例(38.67%),AEA悬空率38.67%,AEA悬空与AEA非悬空患者AEA至额嘴长度差异无统计学意义(P>0.05);不同Keros分型的AEA悬空率差异有统计学意义(P<0.05),且Spearman相关性分析显示,AEA悬空率与Keros分型呈正相关(r=0.613,P<0.001);Gera分型Ⅰ型35例(23.33%),Ⅱ型108例(72.00%),Ⅲ型7例(4.67%),Gera分型与Keros分型无显著相关性(P>0.05);150例患者(300侧)中,SAUP分型Ⅰ型164侧(54.67%),Ⅱ型16侧(5.33%),Ⅲ型12侧(4.00%),Ⅳ型60侧(20.00%),Ⅴ型48侧(16.00%),钩突内引流162侧,钩突外引流138侧,钩突内引流额窦炎发生率高于钩突外引流(P<0.05)。结论慢性鼻窦炎鼻内镜术前行鼻窦CT检查,可明确AEA位置、LLCP-CP角、SAUP位置等的解剖变异情况,有助于识别颅底损伤高风险患者。

Root Canal System Variation in Mandibular Second Molar: Middle-Mesial Canal

Middle-mesial canals in mandibular molars are present in the population depending on age, sex and ethnicity. However, limited literature alludes to its prevalence. Troughing procedures may enhance identification, cleaning and shaping. This case report expresses the recognition and management of middle-mesial canal in a mandibular second molar of 24 years old Hispanic-Latino male.

Study of morphologic variability of incudostapedial angle and its relation with temporal bone pneumatization

Introduction:Optimal sound transmission across the ossicular chain is dependent on the appropriate alignment of the middle ear ossicles.Incudostapedial joint(ISJ)is conventionally considered to be at right angle.Objective:We intended to study the ISJ anatomy and the impact of temporal bone pneumatization on the same.Methods:In a cadaveric study comprising of 47 human temporal bones,canal wall down mastoidectomy was carried out under microscopic guidance keeping the ossicular chain intact.The morphology of ISJ was recorded and analysed with respect to the pneumatization status of the temporal bone.The data analysis was performed using statistical software Stata version 12.0.Results:The mean ISJ angle for the 47 bones was 90.5^0(SD-15^0;range:54^0-122^0).The mean angle in well pneumatized bones was 93.7^0(SD-16.5;Range:54°-122^0)and in sclerotic mastoids was 88.7^0(SD-14;Range:68°-118^0).The difference in the ISJ angle in these two conditions was not statistically significant(p=0.27).The mean angle was found to be significantly more obtuse in the cases with partially eroded ISJ(111.4^0{SD-8.8;range:100.3^0-221.9^0};p=0.0001)and in the cases with an‘adherent/tilted morphology’of the stapes suprastructure with the promontory(mean-95.8^0(SD-13.8;range:70.7^0-120.4^0);p-<0.00001).Conclusion:The ISJ angle shows considerable variations.This variability needs to be taken into account when undertaking middle ear reconstructive procedures,specifically the ones involving the stapes footplate.The mastoid pneumatization does not appear to have an impact on the ISJ angle.

Appendicitis in double cecal appendix: Case report

Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.