BIO 475 Patient Case

Presentation
Presenters: Anjelina Humphreys, Brenna Moya,
Haadia Janjua, Katelyn Patrick
Patient Demographics

● Age: 79 years old

● Female
● Height: 5’ 6’’
● Weight: 210 lbs
● Nicknamed Ida
Anatomical Variations and Findings
Brachial Plexus Variations

● Split Lateral,
Medial, and
Posterior cords
Split medial cord

Split lateral cord

Image 1: Split cords of the left brachial plexus

Right Renal Accessory Artery

● Pre-caval accessory artery

IVC
● Important for surgical Kidney
intervention
● About a 6% occurrence

Aorta

Vasculature of the R. renal artery

Accessory
R. Renal
Normal Whole Body
Artery
Anatomy Donor
 Trifurcation of the Left Coronary Artery
- Out of 75 cadaver cases,
trifurcation of the LCA occured in
14.6% of them
- Associated with the atherosclerosis
of coronary artery disease (CAD)
- Increases risk for myocardial LCA
infarction
LAD
Normal Variation

C. A. Circumflex a.
LCA LCA
C. A.
LAD LAD Extra Marginal a.
Trifurcation of LCA, Extra
marginal artery 68.55 mm in
Extra M. A. length
 Duplicated Posterior Interventricular Arteries (PIA) SA Nodal
a.

- Research associates duplication

RCA
of PIA with increased blood
supply to the interventricular
septum due to the atheroclerotic Extra
lesions of the LAD PIA

Normal Variation PIA

C. A. C. A.

RCA RCA

PIA PIA 2 PIA 1

Double occurrence of the posterior
interventricular artery
Conditions and Diseases
Tricuspid Valve (TV) Stenosis

- Most common cause is

endocarditis stemming
from rheumatic fever
- TV stenosis results
in TV insufficiency
as blood flow is
obstructed from the
narrowing of the TV
orifice
Hypertrophy of the Right Ventricle (RV)

- Hypertrophy of RV is classified as
lateral wall thickness greater
than 5mm.
- Most likely develop to compensate
for tricuspid valve insufficiency

Interior view of right ventricle; right

ventricular wall thickness of 12.94 mm.
Renin-Angiotensin-Aldosterone System (RAAS) Activation

Right-sided Leads to decrease RAAS system is

heart failure output activated

Renin converts Kidneys release

ACE converts angiotensinogen
angI to angII renin
to angI

AngII binds to ATR1

Renin-Angiotensin-Aldosterone System (RAAS) Activation
AngII binds to ATR1
Heart Pathway Liver Pathway

ATR1 binding activates ATR1 binding activates

cardiac fibroblasts HSCs
proliferation
Activated HSCs convert to
myofibroblasts
Cardiac fibroblasts
produce ECM Myofibroblasts produce
components ECM components
Leads to CT deposits

CT deposits impairs organ

function
Cardiac Remodeling
- Distribution of
connective tissue
through cardiac muscle
is indicative of
cardiac remodeling
- Common cause of cardiac
remodeling is cardiac
dysfunction

Histology sample of connective tissue from the left

ventricle
Liver Fibrosis
- Liver fibrosis starts in the
portal triads
- 1st stage of liver fibrosis
- Fibrocytes are stimulated by
angiotensin II

Typical Excess
amount of connective
connective tissue
tissue
Liver Fibrosis
Average
Sinusoidal
diameter

- Hepatic sinusoidal
dilation
- Caused by hepatic
venous outflow Sinusoidal
obstruction Dilation
- High venous pressure
Normal Liver Sinusoids
is caused by right
sided heart failure
- No liver failure
- No signs of ascites
- No hepatomegaly or
splenomegaly
- Beginning stages or
managed with
medication
10x magnification of hepatic Sinusoids
Increased Size of Ventricles Thinned Corpus
Callosum
Corpus Callosum

Midsagittal view of normal brain Midsagittal view of enlarged Lateral

and third Ventricles
Increased Size of Ventricles Defect within the septum
pellucidum caused by stretching of
the ventricles measuring 38.45mm.

Midsagittal view of normal Midsagittal view of enlarged

brain lateral and third Ventricles
Increased Size of Ventricles
Interventricular Foramen, measured
at width 9.24 mm; The third
ventricle measured 38.45 mm in
length
Interventricular
Foramen
Normal cadaveric brain pointing to
the Interventricular foramen; Average
diameter in one study was 1.6 by 1.5
mm. Average lengths of third
ventricle was 3.3 mm in normal
patients.
Increased Size of Ventricles

Midsagittal view of enlarged ventricle size

CAT scan imaging of 90 y/o female

brain with no detectable Posterior view of the enlarged size of
abnormalities right and left ventricles
Hydrocephalus - Increased CSF

1. Overproduction

2. Obstruction

3. Decreased Absorption
Calcification of the Brain

CAT Scan imaging of the lateral and superior

view of the cranial region; increased
calcification of the pineal gland and falx
cerebri

Arachnoid granulations on the right

cortex
Cause of Death
Head Trauma

- Found a significant
subdural hematoma on the
right hemisphere
- Stroke was not evident as
the hemorrhage was not
subarachnoid
- Hematoma was most likely
caused by head trauma

Superior view of brain and right

subdural hematoma
Asymmetry of the Internal Jugular Veins

Right internal Left internal

jugular vein jugular vein

had lack of distended

blood
Sigmoid Sinus Thrombosis
 Minor Head
Injury

Sigmoid Sinus
Thrombosis
Calcified
Arachnoid High Venous Subdural
Granulations Pressure Hematoma

Decreased
reabsorption
of CSF

Hydrocephalus

High ICP
 High ICP

Tentorial Herniation

Bradycardia Irregular
respiration/apnea

Decrease in
stroke
volume Lack of oxygen
to tissues
Decrease in
blood flow to
tissues
Death
Acknowledgements

Whole Body Donor Participants and Families: Their

immeasurable contributions to the learning process are so
important to the scientific community and to us as students
and future physicians.
Dr. Alla Barry, Maya Greenquist (TA), and Amanda Johnson
(TA): Contribution to research and the learning process
Missouri Southern State University: The opportunity to learn
and grow as students
Works Referenced
Anan, Rania Adel. “Arachnoid Granulation: Radiology Reference Article.” Radiopaedia, Radiopaedia.org, 18 June Lo, Regina C, and Haeyoung Kim. “Histopathological evaluation of liver fibrosis and cirrhosis regression.” Clinical
2023, radiopaedia.org/articles/arachnoid-granulation?lang=us. and molecular hepatology vol. 23,4 (2017): 302-307. doi:10.3350/cmh.2017.0078

Bair MM, Murakami S. Neuroanatomy, Falx Cerebri. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Mamaliga, Tatiana, and Mohiuddin Hadi. “An Unusual Vermiform Giant Arachnoid Granulation.” Radiology Case
Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545304/ Reports, Elsevier, 23 Oct. 2019, www.sciencedirect.com/science/article/pii/S193004331930319X?via%3Dihub.

Bataller, Ramón, and David A Brenner. “Liver fibrosis.” The Journal of clinical investigation vol. 115,2 (2005): Mir, Nasir Syed et al. “Bilateral Duplication of Renal Vessels: Anatomical, Medical and Surgical perspective.”
209-18. doi:10.1172/JCI24282 International journal of health sciences vol. 2,2 (2008): 179-85.

Brancatelli, Giuseppe et al. “Hepatic sinusoidal dilatation.” Abdominal radiology (New York) vol. 43,8 (2018): Srivastava, Shubha et al. “Clinical insight into the precaval right renal artery: a multidetector row computed
2011-2022. doi:10.1007/s00261-018-1465-8 tomography angiographic study.” ISRN anatomy vol. 2013 250950. 26 Mar. 2013, doi:10.5402/2013/250950

Dass C, Kanmanthareddy A. Rheumatic Heart Disease. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Stensaas, Suzanne S. “Neuroanatomy Video Lab: Brain Dissections.” Brain Dissections: Neuroanatomy Video
Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538286/ Lab, neurologicexam.med.utah.edu/adult/html/brain-dissections.html. Accessed 2 Dec. 2023.

Dixon, Andrew. “Elderly CT Brain: Radiology Case.” Radiopaedia, Radiopaedia.org, 24 Nov. 2022, Tan DX, Xu B, Zhou X, Reiter RJ. Pineal Calcification, Melatonin Production, Aging, Associated Health
radiopaedia.org/cases/elderly-ct-brain. Consequences and Rejuvenation of the Pineal Gland. Molecules. 2018 Jan 31;23(2):301. doi:
10.3390/molecules23020301. PMID: 29385085; PMCID: PMC6017004.

Faria, Silvana C et al. “MR imaging of liver fibrosis: current state of the art.” Radiographics : a review publication
of the Radiological Society of North America, Inc vol. 29,6 (2009): 1615-35. doi:10.1148/rg.296095512 Tubbs, R.S., Oakes, P., Maran, I.S. et al. The foramen of Monro: a review of its anatomy, history, pathology, and
surgery. Childs Nerv Syst 30, 1645–1649 (2014). https://doi.org/10.1007/s00381-014-2512-6

Gupta, Anupma, Gupta, Raman, Singhal, Rikki, “Precaval Right Renal Artery: A Cadaveric Study Incidence and
Clinical Implications” International Journal of Biological & Medical Research. 2011; 2(4): 1195-1197
Anatomical Distinctions of the Heart

- Trifurcation of LCA
- Double interventricular posterior arteries
- Right interventricular hypertrophy
- Ballooning of chordae tendineae of tricuspid valve

- Increased CT (seen in histology) possibly lead to

congestive heart failure
Anatomical Variations and Findings not contributing to COD
Kidneys Liver Increased Nervous System Musculature Heart
Ossification

Accessory R. Renal Cirrhosis of tissue Calcifications of Double cords of R. Ballooning of

artery anterior to (increased falx cerebri and and L. sides of chordae
IVC prevalence of CT pineal gland brachial plexus tendineae of
seen in biopsy) tricuspid valve

Irregular R. Renal Increased skeletal Hypertrophy of

vv. anastomosis thickness of right ventricle
occipital
protuberance
Brain

- Enlarged brain size

- Increased size of ventricles
- Increased cranial pressure +/- accumulation of CSF
- Right Subdural Hematoma
- Not usually fatal but possible in this case due to increased cranial
pressure/ lack of space
- Calcification of falx cerebri
- Calcification of pineal gland (shown in CAT scan)
- Calcified Arachnoid Granulations
Brain

Break up into multiple slides to include all imaging and

explanation:
Discuss findings of brain, including increased intracranial
pressure and increased volume and size of ventricles
- What would cause these issues, what are common factors of
association in adults
Mentions things not present (rule out non-observed issues):
includes tumors and the fact that no strokes were observed
Ossifications of the Brain
Increased Size of Ventricles

Image A: CAT scan imaging of 90 y/o female Image B: CAT scan imaging of enlarged ventricles
brain with no detectable abnormalities
Ossifications of the Brain
Calcifications of the Brain

Falx Cerebri: More common in female pts., common region for

age-related calcification, associations w/ Gorlin-Goltz
syndrome
Pineal Gland: High calcification rate, incident rates
increase w/ age
Arachnoid Granulations: Size and frequency associated w/
aging
Ossification leads to decreased CSF uptake