wandering or floating(gall blader without galbladder fossa)

the floating galbladder being lifted to the extreme right surface of the liver.

the galbladder is lifted up to the extereme left side of the liver.the fundus ,body and cystic duct were all being lifted upfrom the inferior surface.s

            the galbladder is fully lifted up from the inferior surface,the peritoneum is seen covering the entire gal bladder fossa.

the fundus of the galbladder is not  reaching(falling short of) the inferior border of the liver

the small gal bladder in its fossa ,not able to reach the inferior border of the livSer

wandering or floatinggalbladder seen on inferior surface of the liver, there is  no gal bladder fossa

 

liver with diaphragmatic fissure

Accessory renal artery

Left kidney with twin accessory renal arteries

During the routine dissection hours a cadaver displayed a left kidney supplied by two accessory renal arteries which branched out from the aorta and had a sinuous course.  The main renal artery (MRA) was seen  entering into the hilum behind the main renal vein(MRV) .

The first accessory renal artery(ARA-1)  branched from the left lateral side of the aorta just above the level  of superior mesenteric artery.

It was running laterally showing a kink almost in the centre of its course. It entered into the  kidney through the anterior substance of the kidney just above the hilum.

A  segmental branch was seen entering the hilum lying anterior to the main renal vein.

The 2^nd accessory renal artery(ARA-2) was seen arising about 5.7 cms below the origin of superior mesenteric artery(SMA) .  It is longer than the 1^st accessory renal artery  extending laterally from the aorta it is seen entering into the left kidney just below the renal pelvis. A gonadal branch was seen branching out . The left gonadal vein( LGV) is seen draining into the left renal vein .

The hilum was extending over to the anterior surface of the kidney and crowding of the vascular structures was seen . However the pelvis remained most posterior .

Clinical significance

Presence of such twin renal arteries can complicate the interpretation of renal angiograms and challenge the urologists performing laparoscopic and renal transplantation procedures   

Acknowledgements:

Special thanks to  Manisha , swatika, Atif , kareem and Shahzeb zaman.( MBBS students of 2010-11 batch Shadan Medical College . Hyderabad . India)

Tri-lobed left lung

A female cadaver in the routine dissection hours of Ist MBBS Students revealed a trilobed left lung


ZOOM IN. PERICARDIUM RT LUNG LEFT LUNG DIAPHRAGM ALSO SEEN

The  Thoracic viscera insitu (right lung, pericardium with heart , left lung ) after the removal of anterior thoracic wall .Image shows the placement of forceps in the horizantal fissures bilaterally .

Lt Lateral view showing 3 lobes of left lung in situ.

 Diaphragm also seen

A pair of forceps is placed both in the horizontal and oblique fissures are seen. Cardiac notch of lung also seen.

Tri lobed left lung with oblique and horizontal fissure dissected out showing oblique and horizotal fissures

Anterior border of trilobed left lung showing the cardiac notch and lingula

TRILOBED LEFT LUNG DUE TO AN ACCESSORY HORIZONTAL FISSURE

During the dissection, a female cadaver displayed the left lung with two fissures just as the right lung.

Both the right and left lung were having the horizontal and oblique fissures at the same level.  The horizontal fissures of the left lung divided the entire lung parenchyma of the upper lobe into two lobes.   it was prominently seen on both costal and mediastinal surfaces.   During the development as the lung grows, the fissures that seprate budding individual bronco pulmonary segments get obliterated except along two planes which in fully formed lungs persists as horizontal and oblique fissures.  The accessory fissure could be the result of non-obliteration of spaces which normally do obliterate.   The accessory fissure may be of varying depth occurring between two broncho pulmonary segments.   In the present case it was deep.  Radiologically an accessory fissure can be mistaken for a lung lesion.   Most of the times the accessory fissures act as a barrier to the spread of infection creating as a sharply marginated pneumonia which could be wrongly interpreted as consolidation / atelectasis. Thus challenging the radiologists expertise. 

Note: 

1.       usually the left lung has only one deep oblique fissure, spiral in its course dividing it into two lobes.  And upper (superior) lobe forming the apex and the anterior margin of  the lung and the lower (inferior ) lobe forming the diaphragmatic major part of the posterior surface.

2.       The presence of oblique fissure in a normal scenario enables the uniform the expansion both the upper and lower lobes of the left lung.

3.       The fissures act as a reliable land mark in specifying thoracic and particularly pulmonary lesions