For trauma, the traditional approach to the proximal left subclavian artery is through a posterolateral thoracotomy. The purpose of this study was to evaluate the feasibility of accessing the proximal left subclavian artery through a partial sternotomy approach. Anatomical review of 52 subclavian arteries was performed on 52 randomly picked computed tomography (CT) scans of the thorax. The depth of the origin of the subclavian artery was measured from the lateral thoracic wall and from the sternum. It was noted that the distance from the sternum to the origin of the left subclavian artery was 4.71 cm as compared to the posterolateral wall, which was 8.87 cm. This is in contrast to the belief that the left subclavian artery is a posterior structure in the mediastinum. A subclavian artery aneurysm was repaired through the sternal approach and was noted to have an adequate exposure required for the procedure. This approach was necessitated owing to the fact that the patient had significant chronic obstructive pulmonary disease. From these data, the authors conclude that in elective circumstances it is easier and appropriate to use the partial sternotomy approach to access the proximal left subclavian artery, especially in patients who have reduced pulmonary function.

No abstract

No abstract

Coccidioides ssp. is a parasitic dimorphic fungus predominantly found in the western and southwestern regions of the United States. The spherule form of this opportunistic organism is responsible for a host of tissue infections in humans, most commonly pneumonia. CNS involvement by coccidioides is an uncommon but well recognized complication, typically manifesting as basilar meningitis. The hyphal form, which existsts naturally in soil, is rarely diagnosed in human infections. Most case reports note infection with the hyphal form only in oxygenated tissues such as lung or osteomyelitic sinus tracts. There are only very rare reports of the hyphal form in the CNS and always in association with aerated surgical devices. We report a coccidioides meningitis and mycotic anyseursm of the basilar artery in a 24‐year‐old pregnant female with a history of HIV. Histologic examination of GMS‐stained sections showed numerous branching hyphae, arthrospores and occasional spherule forms, admixed with amultinucleated giant cells and acute inflammation. Microscopic granulomas were also seen in the subarachnoid space distributed in a military pattern. We believe this to be one of the first reports of a coccidioides ssp. infection with prevalent hyphae forms in the nonoxygenated CNS.