No abstract

Intro Congenital abnormalities of the inferior vena cava (IVC) are rare in the general population with the incidence of IVC duplication being between 0.2 – 3%. Persistent left superior vena cava (SVC) has an incidence of 0.3 – 0.7%. It is important to identify such variations through imaging prior to various thoracic and abdominal surgeries to minimize peri‐operative complications. Methods Two cadavers with vena caval abnormalities were identified in a medical school cadaveric anatomy lab. The donor’s age, sex and cause of death were identified through bequeathal services. The pathway of the aberrant structures was identified through dissection and any tributaries along their courses were isolated. Surrounding structures were examined to identify any other concurrent abnormalities. Results We identified two cadavers with vena caval abnormalities. The first case was a 75‐year old female whose cause of death was a bowel obstruction with comorbid dementia. On this cadaver we identified a persistent left SVC that originated from the brachiocephalic vein on the left side that measured 19 mm in diameter. The aberrant structure drained into the right atrium via the coronary sinus, which was noticeably enlarged. The second case was a 76‐year old female whose cause of death was multiorgan failure with comorbid end stage liver failure, pulmonary edema and hypothyroidism. We identified a duplicated IVC with a diameter of 12 mm originating at the left iliac vein and draining into the left renal vein. Along the duplicated IVC were multiple branches originating from the posterior abdominal cavity. Conclusion We present here two cases with rare vena caval abnormalities found in cadavers in our anatomy lab. The embryological origin of a duplicated IVC stems from the persistence of both left and right supracardinal veins during development. A persistent left SVC occurs when the left superior cardinal vein fails to regress inferior to the brachiocephalic vein. Although rare, recognizing these anatomical variations bears clinical relevance, especially in a surgical setting. These abnormalities are important to identify pre‐operatively to avoid unexpected peri‐operative complications.

Objective: The objectives of this study are to present a case series of immunodeficient children who underwent a transcervical thymic biopsy and to describe the transcervical approach to the thymus gland. Design: Case series. Setting: Pediatric otolaryngology practice in an academic setting. Patients: Consecutive sample of immunodeficient children (≤18 years old) who underwent thymic biopsies from 1996 to 2019 for the purpose of confirming or excluding profound T cell immunodeficiency. Intervention: Diagnostic transcervical thymic biopsy. Results: A total of 14 patients with atypical combined immunodeficiency underwent the procedure during the study period, with minimal post-operative complication. The thymus was found to be abnormal histologically in 9 children and normal in another 5 patients. In all cases, thymus morphology helped define the extent of the immunodeficiency, resulting in either supporting a decision to perform a bone marrow transplant (8 patients) or avoid this high risk procedure (3 patients). Conclusion: Thymus biopsy is helpful in the characterization of childhood immunodeficiency and provides critical information that affects the medical management. The transcervical approach to the thymus is feasible in children and can be accomplished with minimal morbidity. Statement of novelty: Biopsies of the thymus have assisted in the characterization of new entities of primary immunodeficiency.