Anomalous High Transverse Course of Brachiocephalic Trunk and its Clinical Significance: A Rare Case Report

Abstract

The branching pattern and the course of brachiocephalic trunk in relation to the trachea, thyroid gland has profound surgical importance. Any alteration in the normal course of the brachiocephalic trunk, if accidently ruptured during emergency tracheostomy or thyroid surgeries may lead to haemorrhage. Hence, anomalous course of vessels in the neck and thorax should be kept in mind to prevent iatrogenic injury to abnormal vessels. We present a case with a variable course of brachiocephalic trunk passing left to right transversely crossing trachea in a formalin fixed female cadaver. In this case report, brachiocephalic trunk had its origin from the arch of aorta to the left of trachea corresponding to the left margin of manubrium sterni. Then, it ascended along the left margin of trachea up to the lower border of the left lobe of thyroid gland taking a sharp bend of approximately 90° to hook around and cross the trachea transversely to the right side along the inferior margin of the right lobe of thyroid gland. Knowledge of the variable rather transverse course of the brachiocephalic trunk appears to be important in various surgical approaches such as tracheostomies, thyroidectomies and mediastinoscopies.

Keywords

• arch of aorta
• innominate artery
• tracheostomy
• thyroid gland