The Brachiocephalic Trunk Variant Origin and High-Riding Course: Two Cadaveric Cases

Abstract

<p><strong>Objective</strong>. The current report describes two rare cadaveric findings of a left sided brachiocephalic trunk (BCT) in relation to the trachea, and its high-riding course above the suprasternal notch (SN).</p><p><strong> Cases Descriptions</strong>. In two elderly body donors dissected after death, a left-sided BCT was identified with a high-riding course (0.5 and 0.8 cm above the SN). The BCT originated from the aortic arch, in common with the left common carotid artery, more distally than the typical left-side location and crossed in front of the trachea. In the 1st case, the ascending and descending aortae, and the left subclavian artery had aneurysmal dilatation. In both cases, the trachea was displaced to the right side and had a stenosis due to the chronic compression.</p><p><strong>Conclusion</strong>. A high-riding BCT is of paramount clinical importance, as it may complicate tracheotomy, thyroid surgery and mediastinoscopy, leading to fatal complications. BCT injury leads to a massive bleeding during neck dissection (level VI), when the vessel crosses the anterior tracheal wall.</p>

Important Variations of Aortic Branches: Imaging Case Series

“…Highriding BCA can go as high as the level of cricoid and thyroid cartilage, hence overlapping with the thyroid gland [6,7]. Its presence has been correlated with potential complications such as fistulas and bleeding with surgeries and interventional procedures in the neck including thyroid surgery, mediastinoscopy, percutaneous tracheotomy, and placement of central venous catheters [6][7][8][9][10][11]. Cases of hemorrhage and fistulas in neck surgeries such as thyroidectomy and tracheostomy have been attributed to high-riding BCA [12][13][14].…”