Surgical and radiologic anatomy : SRA
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Case Reports
Persistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases.
Variations in the course of the blood vessels are often incidental findings during clinical examination. A persistent left superior vena cava (LSVC) is really not rare (healthy individuals, 0.3-0.5%; patients with congenital heart disease, 4%) and serious complications have been described during catheterization in adults with LSVC (shock, cardiac arrest, angina). ⋯ Subsequently we suggest a classification of superior vena cava according to the positioning of a central venous catheter on the chest radiograph: type I, normal anatomy; type II, only persistent left superior vena cava; type IIIa, right and left superior vena cava with connection; type IIIb, right and left superior vena cava without connection. This classification is illustrated by four clinical cases.
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The carotico-clinoid foramen is the result of ossification either of the carotico-clinoid ligament or of a dural fold extending between the anterior and middle clinoid processes of the sphenoid bone. It is anatomically important due to its relations with the cavernous sinus and its content, sphenoid sinus and pituitary gland. In this study the ossification state of the carotico-clinoid ligament, the diameter of the internal carotid artery and the carotico-clinoid foramen has been studied on 50 autopsy cases. ⋯ The existence of a bony carotico-clinoid foramen may cause compression, tightening or stretching of the internal carotid artery. Further, removing the anterior clinoid process is an important step in regional surgery; the presence of a bony carotico-clinoid foramen may have high risk. Therefore, detailed knowledge of the type of ossification between the anterior and middle clinoid processes can be necessary to increase the success of regional surgery.