study: CT Chest
age: 53 yr.
You Make the Call
No pertinent history.
53 year old male.
CT: This person has a very small innominate (brachiocephalic) artery-- see straight arrow image 5.
Does this vessel look large enough to supply the cephalus (head) and brachium (arm)?
The lower half of the study (second film) provides good opportunity to review normal cardiac anatomy by CT.
This particular variation is relatively uncommon. For answer and discussion see your Moore and Dalley “Clinically Oriented Anatomy” page 147 (text in blue box) and page 148 (diagram). This person did not have “dysphagia”.
This case introduces the concept of “normal anatomic variations”. How important they are depends on the type of medicine you will practice. A cardiothoracic surgeon needs to be familiar with nearly all the possibilities involving the great vessels, in order to avoid surprises. An internist, however, may only want to know the two or three most common ones which could lead to symptoms or problems for his or her patients. You will no doubt find some normal variants in your cadavers.
Also not the midline cleft in the manubrium and sternum. It has literally been sawed in half. This procedure is called a median sternotomy. This is how the cardiothoracic surgeons gain access to the heart.
This man has had a coronary artery bypass graft (CABG). Note the metallic clips near the left anterior descending (interventricular) coronary artery (image 14).
Look at the structure marked by curved arrow in Image 6.
Trace it up and down.