Anat Cell Biol.  2023 Mar;56(1):155-159. 10.5115/acb.22.213.

Vascular anatomy and their variations in Situs inversus totalis using postmortem computed tomographic angiography

• Zangpo D
• Nakane H
• Iino M

• KMID: 2540996
• DOI: http://doi.org/10.5115/acb.22.213

Abstract

Studies describing the vascular systems and their variations in Situs inversus totalis (SIT) from a whole-body computed tomographic (CT) angiography perspective are lacking. We report a case of SIT in which postmortem CT angiography (PMCTA) was performed as a part of the forensic death investigation and incidentally detected several vascular variations in it. The PMCTA procedure was performed using the multiphase PMCTA protocol. Almost all major vessels were visualized, indeed in a completely reversed pattern. Contrast mixture flow interruptions were noted in the right coronary arterial branches suggesting possible blockage, upon which autopsy revealed >90% vessel occlusions at several locations. As such the cause of death was due to ischemic heart disease. Anomalous origins of the right internal mammary artery; abnormal left thyrocervical trunk and variations in the drainage of testicular veins were noted. Our findings might be helpful to clinicians and add to the body of literature on SIT.

Keyword

Computed tomography angiography; Internal mammary artery; Situs inversus; Gonadal veins; Thyrocervical trunk

Figure

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  Fig. 1 3D VR reconstruction of the heart and great vessels. A dynamic phase of MPMCTA. Right-sided heart, the apex pointing towards the right (star) and AA emerging from the right ventricle. AA, ascending aorta; VR, virtual reconstruction; MPMCTA, multiphase postmortem computed tomographic angiography; 3D, three-dimensional.

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  Fig. 2 3D VR reconstruction of coronary arteries. Arterial phase of MPMCTA. Note the contrast flow interruptions shown as filling defects (short arrows). VR, virtual reconstruction; MPMCTA, multiphase postmortem computed tomographic angiography; RCA, right coronary artery; LCA, left coronary artery; CA, circumflex artery; ADA, anterior descending artery; PDA, posterior descending artery; 3D, three-dimensional.

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  Fig. 3 3D VR reconstruction of the right anterior neck. Arterial phase of MPMCTA. Note the common origin of the right IMA with other arterial branches, namely the TCA and SSA. VR, virtual reconstruction; MPMCTA, multiphase postmortem computed tomographic angiography; IMA, internal mammary artery; TCA, transverse cervical artery; SSA, suprascapular artery; AA, ascending aorta; BcA, brachiocephalic artery; CA, common carotid artery; VA, vertebral artery; ThyCT, thyrocervical trunk; ITA, inferior thyroid artery; ACA, ascending cervical artery; DACA, deep ascending cervical artery; DScA, dorsal scapular artery; SCA, subclavian artery; DA, descending aorta; 3D, three-dimensional.

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  Fig. 4 3D VR reconstruction of the left anterior neck. Arterial phase of MPMCTA. Note the common origin of the left ThyCT with another atypical arterial trunk, which is comparatively large. VR, virtual reconstruction; MPMCTA, multiphase postmortem computed tomographic angiography; ThyCT, thyrocervical trunk; BcA, Brachiocephalic artery; CA, carotid artery; VA, vertebral artery; IMA, internal mammary artery; ITA, inferior thyroid artery; ACA, ascending cervical artery; DACA, deep ascending cervical artery; SSA, suprascapular artery; DScA, dorsal scapular artery; SpCA, superficial cervical artery; SCA, subclavian artery; 3D, three-dimensional.

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  Fig. 5 3D VR reconstruction to separate the testicular vessels. A dynamic phase of MPMCTA. Notice dilated & tortuous (varicocele) left testicular vein draining into the left renal vein. Right testicular vein coursing inwards and draining into vesicle venous plexus. Normal testicular arteries. VR, virtual reconstruction; MPMCTA, multiphase postmortem computed tomographic angiography; AO, abdominal aorta; IVC, inferior vena cava; 3D, three-dimensional.

Reference

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