Daniel Daly’s research while affiliated with Washington University in St. Louis and other places

Two unique presentations of renal anatomy were observed during routine cadaveric dissection. The first case presented with an ectopic malrotated left kidney supplied by supernumerary renal arteries. This kidney was drained by a circumaortic renal vein and an inferior polar vein. In addition to the vascular variations, this kidney had three extrarenal calyces and an anteriorly placed hilum. The second case presented with bilateral variations in renal anatomy. These variations included a left circumaortic renal vein, bilateral supernumerary arteries and veins, and a right testicular artery arising from an artery supplying the right kidney. These cases give insights into the high variability of renal anatomy, the clinical importance of atypical renal anatomy, and the embryological development of the renal system.

Numerous vascular variations were observed in the upper limbs of a 109-year-old female donor to the Gift Body Program of Saint Louis University School of Medicine. Variations in the right upper limb included the presence of a brachioradial artery (BRA), persistent median artery (PMA), and an ulnar-dominant incomplete type B superficial palmar arch (SPA). In the left upper limb, the brachial artery bifurcated normally into the ulnar artery (UA) and radial artery (RA). However, a more developed palmar type of PMA was observed, replacing much of the palmar circulation typically supplied by the superficial palmar branch of the RA, which existed only as a small branch anastomosing with the PMA to form a rare arcus medianoradialis-type SPA. Both PMAs arose from their respective UAs distal to the origin of the common interosseous arteries. The left PMA pierced the median nerve (MN) as it descended the forearm. The extent of these variations together presents a unique case of vascularity in the upper limbs. Knowledge of these variations is pertinent to MN compression pathologies as well as procedures involving the upper limb.

Several urogenital and vascular anomalies were associated with an 81-year-old female cadaver. During routine dissection, three extrarenal calyces, an accessory renal artery originating directly from the abdominal aorta, and a circumaortic renal vein were observed at the left renal hilum. The typical renal anatomical structures were identified at the hilum of the left kidney, from anterior to posterior, as the renal vein, renal artery, and ureter. Three extrarenal calyces exited the hilum of the left kidney and united to form the pelvis, then narrowed and became the ureter which descended 21.5 cm to empty into the bladder. The accessory renal artery originated from the lateral aspect of the abdominal aorta and was 7.3 cm below the left renal artery. A corresponding accessary renal vein, identified as a circumaortic vein, left the hilum 4.5 cm below the left renal vein and traveled posterior to the abdominal aorta to drain into the inferior vena cava.

The presence of an upper subscapular nerve branching from the posterior division of the superior trunk, and it being accompanied by an accessory subscapular artery, is of both clinical and surgical significance. During routine dissection of the root of the neck in a 75-year-old male cadaver, an unusual branch from the third part of the right subclavian artery was observed lateral to the dorsal scapular artery. Continued dissection revealed that this artery traveled between the anterior divisions of the superior and middle trunks of the brachial plexus before traveling alongside a nerve from the posterior division of the superior trunk of the brachial plexus. This artery and nerve descended on the anterior aspect of the subscapularis muscle before piercing into its muscle belly. We believe this to be a previously unreported unique variation of the upper subscapular nerve that is accompanied by an accessory subscapular artery on its course to the subscapularis muscle. Knowledge of anatomical variations like this may lead to decreased complications in nerve blocks and surgical procedures related to the shoulder.

During a routine cadaveric dissection of a 93-year-old male donor, unique arterial variations were observed in the right upper extremity. This rare arterial branching pattern began at the third part of the axillary artery (AA), where it gave off a large superficial brachial artery (SBA) before bifurcating into the subscapular artery and a common stem. The common stem then gave off a division for the anterior and posterior circumflex humeral arteries, before continuing as a small brachial artery (BA). The BA terminated as a muscular branch to the brachialis muscle. The SBA bifurcated into a large radial artery (RA) and small ulnar artery (UA) in the cubital fossa. The UA branching pattern was atypical, giving off only muscular branches in the forearm and a deep UA before contributing to the superficial palmar arch (SPA). The RA provided the radial recurrent artery and a common trunk (CT) proximally before continuing its course to the hand. The CT from the RA gave off a branch that divided into anterior and posterior ulnar recurrent arteries, as well as muscular branches, before it bifurcated into the persistent median artery (PMA) and the common interosseous artery. The PMA anastomosed with the UA before entering the carpal tunnel and contributed to the SPA. This case presents a unique combination of arterial variations in the upper extremity and is clinically and pathologically relevant.

A 77-year-old female cadaver was observed to have a rare branching pattern of the right axillary artery (AA). The first part of the AA typically gives off only a superior thoracic artery (STA) but was observed to give off three branches in the case: a lateral thoracic artery (LTA), a thoracoacromial trunk, and a large common trunk (CT). The LTA travelled to provide a variant STA to the 1st and 2nd intercostal spaces. The CT provided an accessory LTA and accessory thoracodorsal artery before bifurcating into a subscapular artery (SA) and posterior humeral circumflex artery. As expected, the SA further divided into the circumflex scapular artery and thoracodorsal artery. A pectoral artery and the anterior humeral circumflex artery originated directly from the second and third parts of the AA, respectively. Knowledge of AA branching variations is of great clinical significance to anatomists, radiologists, and surgeons due to the high rate of injury to this artery.

Background Hepatic variations are common in the general population with one of the most prevalent variations being the presence of abnormal fissures. Accessory lobes (ALs) of the liver are rare occurrences, and the vessels associated with these lobes are rarely discussed. Case presentation Unique morphological variations were observed in the liver of an 81-year-old male cadaver during routine dissection. Five accessory liver fissures (ALFs) and an AL, seen on the visceral surface, were observed on the liver. Three ALFs located on the diaphragmatic surface were characteristic of a corset liver. The remaining two ALFs presented as two oblique lines on the visceral surface, one on the right lobe and one on the left lobe. The AL was located between the quadrate lobe (QL) and caudate lobe (CL) and maintained a connection to the QL via liver parenchyma. The hepatic triad associated with this AL was composed of a direct branch from the right hepatic artery, a direct branch from the left portal vein, and a component of the biliary system leading to the left hepatic duct. There was also a tributary to the middle hepatic vein directly associated with the AL. These basic elements suggest that the AL is an independent functional hepatic segment. Conclusion Due to its presentation, the AL could be misdiagnosed as a tumor during imaging, which prompts removal surgically. The location of this AL, in regards to the hepatic circulatory system, can compromise its flow resulting in symptoms relating to portal hypertension/injuries. Thus, the presence of this novel AL is particularly significant in the fields of surgery and diagnostic imaging.

The presence of both a superficial ulnar artery (SUA) and persistent median artery (PMA) of antebrachial type is of both clinical and surgical significance. In an 84-year-old female cadaver received through the Gift Body Program at Saint Louis University School of Medicine, the right brachial artery was seen divided into an SUA and radial artery (RA) slightly below the interepicondylar line of the humerus. At the level of the radial neck, the RA sent out the common interosseous artery that then gave off the radial recurrent artery before bifurcating into anterior interosseous artery (AIA) and posterior interosseous artery. The AIA continued to appear to branch into the anterior ulnar recurrent artery and posterior ulnar recurrent artery, as well as a PMA of the antebrachial type. In the hand, the SUA and RA contributed to the complete superficial palmar arch seemingly equally, and the RA was the dominant contribution to the deep palmar arch. Ninety-one other arms were assessed for this variation, and none were observed. Knowledge of an anatomical variation such as this may lead to decreased complications in the planning of surgical bypass grafting.