Structural Anatomy
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21669
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Browsing Structural Anatomy by Author "Fisher, Cara"
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Item Bronchopulmonary Variation in a Case of Situs Inversus Totalis(2018-03-14) Fisher, Cara; Blackwood, TaylorAbstract Background: Situs inversus totalis is the transposition of thoracic and abdominal internal organs across the sagittal plane. The incidence of situs inversus totalis is 1:10,000. This case of situs inversus totalis had variant bronchopulmonary laterality. Through extensive literature review we report no other documented cases of individuals with this anatomical variation. Case Information: This study involved detailed dissection of a 71-year-old male with situs inversus totalis and variant bronchopulmonary structures. This study serves to add to the expanding body of knowledge of situs inversus totalis and variations from the expected laterality. In the expected anatomy of individuals with situs inversus totalis, the right lung is bi-lobed and the left lung is tri-lobed. However, this case is exceedingly rare in that the individual maintained a tri-lobed right lung and bi-lobed left lung. In contrast to this, the cadaver maintained the expected situs inversus laterality of both hilar structures. The cadavers tri-lobed right lung maintained the pulmonary artery superior to the primary bronchus while the cadavers bi-lobed left lung possessed the pulmonary artery anterior to the primary bronchus. All other visceral findings were consistent with the expected laterality. Conclusions: As the cadaver maintained expected laterality of the bronchi and pulmonary arteries but did not maintain expected lung structure, we suggest that these findings may assist current research in determining the specific point in embryological development that laterality is determined. Clinicians, surgeons and radiologists should be aware of situs inversus totalis for diagnostic and therapeutic procedures and current clinical guidelines should take these rare variations into consideration.Item Diagnostic Validation of Dynamic Ultrasound Evaluation of Supination-External Rotation Ankle Injuries(2018-03-14) Fisher, Cara; Johnson, Katelyn; Reeves, Rustin; Wood, Addison; Rabbani, TebyanAbstract Purpose: Definitive diagnosis of syndesmosis injuries can be made with plain film radiographs if the injury is severe enough, but often is missed when severity or image quality is low. Ultrasound diagnosis may circumvent many of these disadvantages by being inexpensive, efficient, and able to detect subtle injuries without radiation exposure. This study evaluates the ability of ultrasound to detect subtle SER ankle syndesmosis injuries with a dynamic external rotational stress test. Methods: Nine male fresh frozen specimens were secured to an ankle rig and stress tested to 10 Nm of external rotational torque with ultrasound monitoring at the tibiofibular clear space. The ankles were subjected to syndesmosis ligament sectioning and repeat stress measurements of the tibiofibular clear space at peak torque. Ankle States Examined: 1. Intact State 2. 75% of AITFL Cut 3. 100% of AITFL Cut 4. Fibula Fx - Cut 8 cm proximal 5. 75% PITFL Cut 6. 100% PITFL Cut Results: Dynamic external rotation stress evaluation using ultrasound was able to detect a significant difference between the uninjured ankle tibiofibular clear space of 4.5 mm and the injured ankle with 100% of anterior inferior tibiofibular ligament cut 6.0 mm (P=.017). Additionally, this method was able to detect significant differences between the uninjured ankle and the injured states. Conclusion: Dynamic external rotational stress evaluation using ultrasound was able to detect stage 1 Lauge-Hansen SER injuries with statistical significance and corroborates criteria for diagnosing a syndesmosis injury at ≥ 6.0 mm of tibiofibular clear space widening.Item MASSIVE RIGHT-SIDED HIATAL HERNIA VARIATION: A Case Report(2018-03-14) Dhume, Mahima; Fisher, Cara; Reeves, Rustin; Farrell, MollyBackground: A hiatal hernia describes a herniation of abdominal contents, typically the stomach, through the esophageal hiatus into the mediastinum. The majority of reported paraesophageal hernias (PEH) are left-sided; although, right-sided hiatal hernias have a better prognosis, there is little mention of them in current literature. Case Information: During a routine cadaver dissection for academic purposes, a massive hiatal hernia was identified in an 84-year-old female. This anatomic variant case presents with the abdominal contents of the entire stomach, pyloric sphincter, and portions of the greater and lesser omentums displaced into the right thoracic cavity. Such hernias can have acute symptoms, chronic symptoms, or present as asymptomatic. In this case report, the donor was thought to have no significant functional abnormalities, although there were reports of gastrointestinal bleeding. Conclusions: We believe this case to be a rare variant due to two factors: the size of the hiatus, and the displacement of the hernia into the right side of the mediastinum. The hiatal surface area (HSA) in this case report was calculated to be 17.41cm2, which is almost three times the established average HSA in normal patients. This case report attempts to add to the body of literature detailing right-sided hiatal hernias. Looking forward, we believe that there is great scope for future research specific to right-sided hiatal hernias and improvement in the quality of life for those who undergo elective PEH repair.Item Variation of Posterior Deltoid Muscle(2018-03-14) Fisher, Cara; Reeves, Rustin; Baillio, MichaelBackground: Shoulder anatomy develops into a complex structure with some of the widest ranges of motion displayed on the human body. Held together entirely by ligaments and muscles, the shoulder a relatively weak joint with many clinical presentations. An overlooked attribute is the anatomic variability within the shoulder region. During a routine dissection, bilateral posterior variants of the deltoid muscle, with an interesting orientation of muscle fibers, were discovered on a 78-year-old female cadaver. These variants show an almost perpendicular orientation to the expected direction of deltoid muscle fibers and are not consistent with any other expected muscle bellies in the region. Case Information: While performing a routine dissection in the gross anatomy laboratory, aberrant deltoid muscle straps were observed bilaterally on a 78-year-old female cadaver. These fibers, seen in the figures below, extend superficially from the lateral aspect of the overlying deltoid and lateral triceps brachii fascias. These fibers then lay on top of the infraspinatus muscle belly. Directionally they run at a perpendicular angle to the posterior deltoid fibers and are contained within a separate fascial sheath lying superficially over the existing muscle bellies. An additional, albeit rather small, set of fibers run from the same deep deltoid and triceps brachii fascias to then lay over the scapular spine origin of the posterior deltoid. Although these fibers are contained within a separate fascial sheath, there appears to be no change in the neurovascular anatomy associated with the posterior shoulder. A separate neurovascular bundle was not noted to accompany either of the variant muscle straps. Conclusions: Aberrant straps of muscle in the deltoid region have been described on several occasions. The shoulder joint is an unstable joint with one of the widest ranges of motion of any joint in the body. Its mobility is derived from the construction of the capsule, which is composed of a network of tendon and connective tissue. Consequently, this joint is the source of a great number of acute and chronic pain cases. Perhaps a portion of these cases may be attributed to the presence of variant muscles influencing the shoulder joint. In addition to pain, the shoulder is a frequent location for a variety of surgical procedures. Effective clinical management of patients with concerning shoulder issues should include consideration of atypical structures, whether intra-operatively or not.