An unusual origin of the celiac trunk and the superior mesenteric artery in the thorax

Abstract

The authors report a case of a 44-year-old male found to have unusual origins of the celiac trunk (CT) and superior mesernteric artrery (SMA) as revealed by routine multidetector computed tomograph (MDCT) angiography. The CT and SMA originate from the thoracic aorta (TA) 21 mm and 9 mm above the aortic hiatus, respectively. The median arcuate ligament (MAL) is located at the level of the L1-L2 intervertebral disc. The course of the CT descends in the thoracic cavity making a 14° acute downward angle in front of the TA; below the level of the MAL, the CT descends, making an angle of 47°. The course of the SMA descends at both the thoracic and abdominal level making an angle of 17°, and having an aortomesenteric distance of 9 mm at the level of the third part of the duodenum. In the present case, the supradiaphragmatic origin of the CT and the SMA was determined by their incomplete caudal descent, associated with a pronounced apparent descent of the diaphragm. A thoracic origin of the CT and SMA and the acute downward aortomesenteric angle (17°) associated with a reduced aortomesenteric distance at the level of the third part of the duodenum (9 mm), although no clinical signs are present, may predispose the patient to develop simultaneously a triple syndrome: the compression of CT by MAL (celiac axis compression syndrome), the compression of SMA by MAL (superior mesenteric artery compression syndrome), and the compression of the duodenum by the SMA (superior mesenteric artery syndrome).

Morphological Variations of Posterior Segmental Artery of the Single Renal Artery. Study on corrosion casts

“…The evidence of the tridimensional distribution of anatomical structures is emphasized by modern imaging methods [8][9][10] and morphological methods of dissection, plastination [27][28][29][30][31] or corrosion casts [32,33]. The corrosion casts highlighting the vascular spatial distribution of elements has a superior value for students and residents training in medicine.…”

“…At the level of abdominal cavity, the collateral branches of the aorta show four major categories of variations: variations of origin [8][9][10][11], variations of number [12][13][14][15][16], variations of trajectory [17][18] and variations of distribution [2][3][4][5]. For the renal arteries, the most common variations are the variation of number [12][13][14][15][16][17][18][19].…”

Branching pattern variations of the celiac trunk and superior mesenteric artery in a 72-year-old white female cadaver

“…Makisalo et al (1993) and Raviprasanna and Kulkarni (2018) reported one case in each of their cohorts that had an accessory LHA arising from the CT [45,56,57]. In its absence (0.38-1.4%), branches of the CT may arise from the aorta [4,7,8,27,28,34,35,38,[42][43][44]58].…”

“…Prakash et al (2011) reported an atypical level of origin in 24% of the cases they studied [29]. Matusz et al (2013) reported a unique case involving a CT and SMA origin from the thoracic part of the aorta, approximately 21 mm and 9 mm above the aortic hiatus [58].…”

Median arcuate ligament syndrome: Predictor of ischemic complications?

“…The ligament is highly variable with an appearance ranging from a well‐defined ligamentous mass to an amorphous area of connective tissue. In some patients, low insertion or high origin of the celiac or renal artery relative to the MAL may cause extrinsic compression of the celiac, mesenteric (Kopecky et al, ; Ilica et al, ; Matusz et al, ), and renal arteries (Ilica et al, ; Arazińska et al, ), as well as, the aorta (Curl et al, ). Compression of the celiac axis by the median arcuate ligament produces characteristic findings that are visible on CT angiography, which demonstrates a characteristic focal narrowing in the proximal celiac axis.…”