Dangerous course of the brachiocephalic trunk and variations of arteries in the cervical region – a cadaveric case report

The variant anatomy of the branches of the aortic arch is of profound surgical relevance. Altered course of these arteries, if unsuspected, could lead to accidental injury to these vessels and subsequent hemorrhage. During routine dissection of a sixty-five year old female cadaver of Indian origin, we observed a rare compendium of vascular variations in the anterior cervical region. These included a high arch of aorta, an abnormally wide brachiocephalic trunk overlapping the left half of the cervical trachea, pre-tracheal (sub-isthmic) course of right subclavian and common carotid arteries, unusual origin of the left sided superior thyroid artery from the left common carotid artery and an accessory inferior thyroid artery originating from the aortic arch. The subsequent course of the right subclavian artery, though normal, was higher than would be expected in the supra-clavicular region. The accessory inferior thyroid artery ran dangerously close to the left tracheal border before it entered the lower pole of the left thyroid lobe. The clinical relevance and probable embryogenesis of such variations have been discussed. We feel it is imperative that the clinician be aware of such arterial deviations.