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A left circumflex aorta with a displaced thoracic duct in a 94-year-old male cadaver: a case report with discussion on embryology
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Department of Paediatric Cardiac Surgery, Jagiellonian University Medical College, Krakow, Poland
open access
Abstract
A left circumflex aorta (LCA) is an extremely rare variation of the thoracic aorta. It is distinguished by a retroesophageal descending aorta that subsequently travels down the right side of the thoracic vertebrae towards the aortic hiatus. Nonetheless, its embryological origin ought not to be overly generalised, but each case should be considered individually due to its unique vascular patterns. This study presents a description of a LCA in a 94-year-old male cadaver. The dissection revealed the descending aorta posteriorly from the trachea and oesophagus and then laterally on the right from the thoracic vertebral bodies. The branching pattern of the aortic arch was typical, so was the course of the left and right recurrent laryngeal nerves. However, the thoracic duct was placed on the right, and drained into the right internal carotid vein. Due to the normal appearance of the ascending part and the arch of the aorta, it is safe to presume that the variation originated from the persistent right dorsal aorta, with the retroesophageal part from the persistent left dorsal aorta.
Detailed understanding of the variations of the thoracic aorta, and the anomalies associated with the LCA, can help to improve management of these conditions, and with that, improve patients’ overall outcomes. Patients with a LCA, or another vascular ring, can either be asymptomatic or present with oesophageal and/or tracheal compression symptoms. Management of this anomaly consists namely of ligation of the patent ductus arteriosus/ligamentum arteriosum and aortic uncrossing.
Abstract
A left circumflex aorta (LCA) is an extremely rare variation of the thoracic aorta. It is distinguished by a retroesophageal descending aorta that subsequently travels down the right side of the thoracic vertebrae towards the aortic hiatus. Nonetheless, its embryological origin ought not to be overly generalised, but each case should be considered individually due to its unique vascular patterns. This study presents a description of a LCA in a 94-year-old male cadaver. The dissection revealed the descending aorta posteriorly from the trachea and oesophagus and then laterally on the right from the thoracic vertebral bodies. The branching pattern of the aortic arch was typical, so was the course of the left and right recurrent laryngeal nerves. However, the thoracic duct was placed on the right, and drained into the right internal carotid vein. Due to the normal appearance of the ascending part and the arch of the aorta, it is safe to presume that the variation originated from the persistent right dorsal aorta, with the retroesophageal part from the persistent left dorsal aorta.
Detailed understanding of the variations of the thoracic aorta, and the anomalies associated with the LCA, can help to improve management of these conditions, and with that, improve patients’ overall outcomes. Patients with a LCA, or another vascular ring, can either be asymptomatic or present with oesophageal and/or tracheal compression symptoms. Management of this anomaly consists namely of ligation of the patent ductus arteriosus/ligamentum arteriosum and aortic uncrossing.
Keywords
left circumflex aorta, thoracic duct, anatomy, embryology, anatomical variation
Title
A left circumflex aorta with a displaced thoracic duct in a 94-year-old male cadaver: a case report with discussion on embryology
Journal
Issue
Article type
Case report
Pages
400-406
Published online
2022-04-20
Page views
2324
Article views/downloads
892
DOI
Pubmed
Bibliographic record
Folia Morphol 2023;82(2):400-406.
Keywords
left circumflex aorta
thoracic duct
anatomy
embryology
anatomical variation
Authors
P. Ostrowski
S. Popovchenko
M. Bonczar
T. Mroczek
J. A. Walocha
M. P. Zarzecki
- Amore D, Casazza D, Casalino A, et al. Symptomatic aberrant right subclavian artery: advantages of a less invasive surgical approach. Ann Thorac Cardiovasc Surg. 2020; 26(2): 104–107.
- Arazińska A, Polguj M, Szymczyk K, et al. Right aortic arch analysis: anatomical variant or serious vascular defect? BMC Cardiovasc Disord. 2017; 17(1): 102.
- Blanco Pampin J, Garcia Rivero A, Morte Tamayo N, et al. Left aortic arch with right-sided descending aorta associated with sudden neonatal death: a case report. Med Sci Law. 2003; 43(4): 353–356.
- Bravo C, Gámez F, Pérez R, et al. Fetal Aortic Arch Anomalies: Key Sonographic Views for Their Differential Diagnosis and Clinical Implications Using the Cardiovascular System Sonographic Evaluation Protocol. J Ultrasound Med. 2016; 35(2): 237–251.
- Cerfolio RJ, Allen MS, Deschamps C, et al. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996; 112(5): 1361–1365.
- D'Cruz IA, Cantez T, Namin EP, et al. Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies. Br Heart J. 1996; 28(6): 722–739.
- Gould SW, Rigsby CK, Donnelly LF, et al. Useful signs for the assessment of vascular rings on cross-sectional imaging. Pediatr Radiol. 2015; 45(13): 2004–16; quiz 2002.
- Hanneman K, Newman B, Chan F. Congenital variants and anomalies of the aortic arch. Radiographics. 2017; 37(1): 32–51.
- Haranal M, Srimurugan B, Sivalingam S. Circumflex aorta: An uncharted territory. Asian Cardiovasc Thorac Ann. 2022; 30(2): 217–225.
- Iwanaga J, Singh V, Takeda S, et al. Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
- Kamran A, Friedman KG, Jennings RW, et al. Aortic uncrossing and tracheobronchopexy corrects tracheal compression and tracheobronchomalacia associated with circumflex aortic arch. J Thorac Cardiovasc Surg. 2020; 160(3): 796–804.
- Konstantinov IE, Puga FJ. Surgical treatment of persistent esophageal compression by an unusual form of right aortic arch. Ann Thorac Surg. 2001; 72(6): 2121–2123.
- Licari A, Manca E, Rispoli GA, et al. Congenital vascular rings: a clinical challenge for the pediatrician. Pediatr Pulmonol. 2015; 50(5): 511–524.
- Manole AM, Iliescu DM, Rusali A, et al. Morphometry of the aortic arch and its branches. ARS Medica Tomitana. 2013; 19(3): 154–159.
- Natsis K, Didagelos M, Gkiouliava A, et al. The aberrant right subclavian artery: cadaveric study and literature review. Surg Radiol Anat. 2017; 39(5): 559–565.
- Paul RN. A new anomaly of the aorta; left aortic arch with right descending aorta. J Pediatr. 1948; 32(1): 19–29.
- Planché C, Lacour-Gayet F. [Aortic uncrossing for compressive circumflex aorta. 3 cases]. Presse Med. 1984; 13(21): 1331–1332.
- Sadler TW. Vascular development. In: Langman’s medical embryology, 14th ed. Wolters Kluwer, Philadelphia 2019: 206–222.
- Sánchez Torres G, Roldán Conesa D. [Left aortic arch without a circumflex segment and a right descending aorta: a hypothetical case and a real example]. Arch Inst Cardiol Mex. 1989; 59(2): 125–131.
- Sheth R, Varghese R, Sivakumar K. Left aortic arch with right descending aorta and severe coarctation: an unusual "vascular clamp" with airway compression. Cardiol Young. 2018; 28(8): 1056–1058.
- Smith BM, Lu JC, Dorfman AL, et al. Rings and slings revisited. Magn Reson Imaging Clin N Am. 2015; 23(1): 127–135.
- Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg. 2015; 63(5): 245–259.
- Türkvatan A, Büyükbayraktar FG, Olçer T, et al. Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol. 2009; 10(2): 176–184.
- Vinnakota A, Idrees JJ, Rosinski BF, et al. Outcomes of Repair of Kommerell Diverticulum. Ann Thorac Surg. 2019; 108(6): 1745–1750.
- Weinberg PM. Aortic arch anomalies. J Cardiovasc Magn Reson. 2006; 8(4): 633–643.
- Yoshimura N, Fukahara K, Yamashita A, et al. Congenital vascular ring. Surg Today. 2020; 50(10): 1151–1158.