Anat Biol Anthropol.  2023 Dec;36(4):147-153. 10.11637/aba.2023.36.4.147.

Abnormal Arrangement of Neurovascular Structures in Superior Mediastinum and Cervical Root in a Case of Situs Inversus Totalis

• Choi NR
• Kwon CY
• Lee MY
• Shin KJ
• Sohn HJ
• Gil YC

• KMID: 2551286
• DOI: http://doi.org/10.11637/aba.2023.36.4.147

Abstract

This study is the case report for the topographic anatomy of the major blood vessels and nerves located in the cervical root and superior mediastinum of a 63-year-old male cadaver with situs inversus totalis donated for research purposes. The internal jugular vein and subclavian vein combined to form the brachiocephalic vein did not differ from the normal case, but the right brachiocephalic vein was formed longer than the left, and crossed the front of the aortic arch to joined into the superior vena cava. The thoracic duct was joined to the right venous angle. The branching order of the main branches of aortic arch was the same as in the normal case: brachiocephalic artery, common carotid artery, and subclavian artery, but the first branch, the brachiocephalic artery, branched into the left common carotid artery and left subclavian artery after branching. Afterwards, the common carotid artery and subclavian artery, which sequentially branched from the aortic arch, traveled to the right cervical root to form the right common carotid artery and the right subclavian artery. The recurrent laryngeal nerve, which branches off from the vagus nerve, also had a left-right reversed pattern compared to the normal running course. The right recurrent laryngeal nerve wound the aortic arch, and the left recurrent laryngeal nerve wound the left subclavian artery and traveled up toward the larynx. Patients with situs inversus totalis are very rare cases, and it is not easy for clinicians to quickly identify the anatomy and positional relationship of nerve and vascular structures during surgery because it is not a familiar form. This study presents in detail the positional relationships of nerves and vascular structures in the cervical root and superior mediastinum of cadavers with situs inversus totalis, so we think this report will be helpfull reducing confusion for surgeons and improving safety during surgery for patients with situs inversus totalis.

Keyword

Situs inversus totalis; Cervical root; Superior mediastinum; Recurrent laryngeal nerve