Carotidynia, also known as Fay syndrome, is a rare syndrome characterised by neck pain in the region of the carotid bifurcation.
There is confusion in the literature as to what this term actually refers to, with some authors suggesting that the term should be reserved for a pain syndrome with n...
Ischaemic colitis refers to inflammation of the colon secondary to vascular insufficiency and ischaemia. It is sometimes considered under the same spectrum as intestinal ischaemia. The severity and consequences of the disease are highly variable.
Ischaemic bowel is typically a dis...
The superior anastomotic vein of Trolard connects the superior sagittal sinus and the superficial middle cerebral vein (of Sylvius).
Its size is dictated by the relative size of the superficial middle cerebral vein and the anastomotic vein of Labbé. The vein of Trolard is smaller than both of t...
Superficial veins of the brain predominantly drain the cerebral cortex, and include:
superior cerebral veins (or superficial cerebral veins)
inferior cerebral veins
superficial middle cerebral veins
superior anastomotic vein (of Trolard)
inferior anastomotic vein (of Labbe)
Some also inclu...
The spinal cord blood supply is formed by many different vessels with an extensive collateral supply and drainage.
The spinal cord is supplied by three longitudinal arteries:
single anterior spinal artery: supplies the anterior two-thirds of the spinal cord
paired posterior s...
Pulmonary hypertension is defined as a resting mean pulmonary arterial pressure of 25 mmHg or greater at right heart catheterisation, which is a haemodynamic feature that is shared by all types of pulmonary hypertension in the Dana Point classification system. A resting mean pulmonary arterial p...
Systemic hypertension is defined medically as a blood pressure greater than 140/90 mmHg.
essential hypertension: idiopathic (95%)
secondary hypertension: underlying cause identified (5%)
Causes of secondary hypertension:
chronic renal failure...
Hypertension refers to an increase in blood pressure above the 'normal' for the age, sex and ethnicity of the patient. This can be specified according to the vascular system involved.
The lenticulostriate arteries are a collection of small perforating arteries arising from the anterior part of the circle of Willis and supplying the basal ganglia.
They are divided into:
medial lenticulostriate arteries
lateral lenticulostriate arteries
There is, however, some confusion a...
The cavernous sinuses are paired dural venous sinuses.
The cavernous sinus (CS) is located on either side of the pituitary fossa and body of the sphenoid bone between the endosteal and meningeal layers of the dura. The normal lateral wall should be either straight or concave.
The middle meningeal artery branches off the first part of the maxillary artery. It passes vertically through the roots of the auriculotemporal nerve and enters the middle cranial fossa via the foramen spinosum. Here it gives off two branches - superior tympanic branch and ganglionic branch - be...
The superior cerebellar artery (SCA) arises from the distal basilar artery, just below the posterior cerebral artery (PCA) and typically supplies:
whole superior surface of the cerebellar hemispheres down to the great horizontal fissure
most of the cerebellar ...
The pontine branches are the small arterial branches of the basilar artery that supply the pons and structures adjacent to the pons.
There are usually 3-5 paired arterial branches which are located in the mid-basilar region between the anterior inferior cerebellar artery and the superior cerebe...
The anterior inferior cerebellar artery (AICA) is one of three vessels that provides arterial blood supply to the cerebellum. It has a variable origin, course and supply, with up to 40% of specimens not having an identifiable standard AICA. The amount of tissue supplied by the AICA is variable (...
The basilar artery is part of the posterior cerebral circulation. It artery arises from the confluence of the left and right vertebral arteries at the base of the pons as they rise towards the base of the brain.
origin: vertebral artery confluence
course: ventral to pons in the pontin...
Posterior inferior cerebellar artery (PICA) is one of the three vessels that provide arterial supply to the cerebellum. It is the most variable and tortuous cerebellar artery.
Its origin is highly variable:
~20% arise extracranially, inferior to the foramen magnum
The vertebral arteries (VA) are paired arteries, each arising from the respective subclavian artery and ascending in the neck to supply the posterior fossa and occipital lobes, as well as provide segmental vertebral and spinal column blood supply.
origin: branches off the 1st part of t...
The posterior communicating artery (PCOM or P Comm) makes up the posterior linkage in the circle of Willis.
The PCOM originates from the posterior aspect of the C7 (communicating) segment of the internal carotid artery and extends posteriormedially to anastomose with the ...
The middle cerebral artery (MCA) is one of the three major paired arteries that supply blood to the brain. The MCA arises from the internal carotid artery (ICA) as the larger of the two main terminal branches (the other being the anterior cerebral artery), coursing laterally into the lateral sul...
The anterior communicating artery (ACOM) arises from the anterior cerebral artery and acts as an anastomosis between the left and right anterior cerebral circulation. Approximately 4 mm in length, it demarcates the junction between the A1 and A2 segments of the anterior cerebral artery.
The posterior cerebral arteries (PCA) are the terminal branches of the basilar artery and supply the occipital lobes and posteromedial temporal lobes.
origin: terminal branches of the basilar artery
course: from basilar towards occiput
posterior communicating artery
The anterior cerebral artery along with the middle cerebral artery forms at the termination of the internal carotid artery. It is the smaller of the two, and arches anteromedially to pass anterior to the genu of the corpus callosum, dividing as it does so into its two major branches; pericallosa...
The beak sign of arterial dissection represents a wedge of haematoma at the distal end of the false lumen. It is here that false lumen propagation is occurring. It manifests as an acute angle between the dissection flap and the outer wall. It may be filled with contrast-enhanced blood (high atte...
Endovascular aneurysm sealing system (EVAS) was developed with the intention to expand beyond the anatomic limitations of endovascular aneurysm repair (EVAR) devices, as well as to decrease the rates of re-intervention secondary to graft migration and type II endoleaks.
EVAS was designed by End...
Rasmussen aneurysm (not to be confused with Rasmussen encephalitis) is an uncommon complication of pulmonary tuberculosis and represents a pulmonary artery aneurysm adjacent or within a tuberculous cavity.
It can be present in up to 5% of patients with chronic cavitary tuberculos...
A coronary artery bypass graft (CABG or CAG) is placed during a surgical procedure to increase blood flow to the myocardium due to coronary stenoses, usually caused by coronary artery disease. Arteries or veins can be grafted during this procedure.
Long term outcome of coronary artery bypass gr...
Lymphocele of the thoracic duct (thoracic duct cyst) is usually asymptomatic or less commonly may present as left supraclavicular fossa mass 1.
The clinical significance of a thoracic duct cyst lies in its misidentification as a pathological lesion at radiological assessment, whi...
Pulmonary embolism (PE) refers to embolic occlusion of the pulmonary arterial system. The majority of cases result from thrombotic occlusion and therefore the condition is frequently termed pulmonary thrombo-embolism which is what this article mainly covers.
Other embolic sources include:
Renal artery stenosis (RAS) refers to a narrowing of a renal artery. When the process occurs slowly, it leads to secondary hypertension. Acute renal artery stenosis does not lead to hypersecretion of renin.
When the stenosis occurs slowly, collateral vessels form and supply the kidne...
The primitive arteries in the brain can be remembered by the following mnemonic:
P: posterior inferior cerebellar (PICA)
A: anterior choroidal
The meningohypophyseal trunk and anterior choroidal and posterior ...
Central venous catheters (CVC) or lines (CVL) refer to a wide range of central venous access devices but can broadly be divided into four categories. They may be inserted by medical, surgical, anaesthetic/ITU, or radiology specialists.
peripherally inserted central catheters (PI...
Basilar artery fenestration (or more simply, basilar fenestration) is the most common intracranial arterial fenestration. It refers to duplication of a portion of the artery. Its reported prevalence is highly variable depending on the technique used:
~0.5% (0.3-0.6%) at angiography (presumably ...
Persistent primitive trigeminal artery (PPTA) is one of the persistent carotid-vertebrobasilar anastomoses. It is present in 0.1-0.6% of cerebral angiograms and is usually unilateral.
In utero the trigeminal artery supplies the basilar artery before development of the posterior communicating an...
The meningohypophyseal trunk, also known as the posterior trunk, is a branch of the C4 segment of the internal carotid artery. In contrast to the inferolateral trunk, it is almost always identified at autopsy and usually visualised on good quality angiography.
It has three branches:
Haemoptysis refers to coughing out blood. Generally, it appears bright red in colour as opposed to blood from gastrointestinal tract which appears dark red. It is considered an alarming sign of a serious underlying aetiology.
Massive haemoptysis is referred to as expectoration of >...
The superior hypophyseal artery (or arteries) is a branch from the C6 segment of the internal carotid artery. It is usually a single trunk which then divides into many small branches, which go on to supply:
pituitary gland (anterior gland)
It is ofte...
The inferior hypophyseal arterial circle, also known as the inferior capsular arterial rete, is an anastamotic arterial network formed around the base of the pituitary gland by branches from three vessels, themselves branches off the cavernous portion of the carotid artery. They are:
Pericardial calcification (PC) usually occurs in patients with a history of pericarditis.
previous trauma or prior pericarditis
later sequelae of rheumatic heart disease
malignant pericardial involvement (e.g. mediastinal teratoma)
On chest radiography, location ...
Constrictive pericarditis (or perhaps better termed pericardial constriction) is a type of pericarditis which leads to diastolic dysfunction and potentially symptoms of right heart failure.
No single demographic is affected as there are numerous causes of constrictive pericarditi...
The circumflex artery (Cx) is a major coronary artery that divides off the left main coronary artery (the other branch being the left anterior descending (LAD) artery).
The circumflex artery is referred to by multiple terms:
circumflex artery (Cx)
ramus circumflex artery (RCx)
Thoracic outlet syndrome (TOS) refers to a group of clinical syndromes caused by congenital or acquired compression of the brachial plexus or subclavian vessels as they pass through the superior thoracic aperture.
Clinical presentation will depend on the structure compre...
Portal venous gas is the accumulation of gas in the portal vein and its branches. It needs to be distinguished from pneumobilia, although this is usually not too problematic, when associated findings are taken into account along with the pattern of gas (i.e. peripheral in portal venous gas, cent...
Intra-aortic balloon pumps (IABP) are used in the intensive care setting to provide haemodynamic assistance to patients in cardiogenic shock.
Function and physiology
The device is comprised of a catheter introduced via the femoral artery, which extends retrogradely to the proximal descending t...
The thoracoacromial artery is a vessel arising from the axillary artery at the axilla.
origin: first branch of the second part of the axillary artery 1
supply: pectoralis major and minor, anterior part of the deltoid, and dermal sensation overlying the clavipectoral ...
The lateral thoracic artery is a branch of the second part of the axillary artery.
Origin and course
The lateral thoracic artery originates from the medial surface of the axillary artery, posterior to the distal part of pectoralis minor. It courses inferomedially along the infe...
The anterior humeral circumflex artery is a vessel arising from the axillary artery at the proximal part of the arm. It is smaller in size relative to the posterior humeral circumflex artery.
origin: branch of the axillary artery at the proximal part of the arm
location: proximal arm...
The posterior humeral circumflex artery is a vessel arising from the axillary artery at the proximal part of the arm.
origin: branch of the axillary artery at the proximal part of the arm 1
location: proximal arm
supply: glenohumeral joint, teres major and minor, and deltoid 1
The aortic isthmus is the part of the aorta just distal to the origin of the left subclavian artery at the site of the ductus arteriosus.
This portion of the aorta is partly constricted in the fetus because of the lack of flow within the aortic sac and ascending aorta. It marks the partial sepa...
The descending aorta is the continuation of the aortic arch in the posterior mediastinum.
The descending aorta commences at the level of the fourth thoracic vertebra body, on its left, in the plane of Ludwig as the continuation of the aortic arch. It descends in the posterior med...
The ascending aorta is the first part of the aorta, and begins at the aortic valve, located obliquely just to the left of the midline at the level of the the third intercostal space. It terminates as it exits the fibrous pericardium where it becomes the aortic arch, in the plane of Ludwig, a hor...
The aortic arch represents the direct continuation of the ascending aorta and represents a key area for a review of normal variant anatomy and a wide range of pathological processes that range from congenital anomalies to traumatic injury.
origin: continuation of the ascending aorta at...
The thoracic aorta is the most superior division of the aorta and is divided into three sections:
The thoracic aorta begins at the aortic valve, located obliquely just to the left of the midline at the level of the the third intercostal space. It ...
Stroke is a clinical designation that refers to the sudden neurological deficit resulting from a cerebrovascular event. It is divided into two broad categories:
ischaemic stroke (80% 2)
haemorrhagic stroke (15%)
secondary haemorrhages: some intrac...
The superior thoracic artery is the only branch of the first part of the axillary artery. It is only a small and highly variable artery.
Origin and course
The superior thoracic artery originates from the first part of the axillary artery, just inferior to subclavius. It courses...
A useful mnemonic to remember the branches of the thoracoacromial artery is:
Useful mnemonics to remember the branches of the axillary artery are:
S AL SAP
Screw the lawyer, save a patient!
S AL SAP
S: superior thoracic artery (from 1st part)
A: acromiothoracic (thoracoacromial) artery (from 2nd part)
L: lateral thoracic artery (from 2nd part)
The subscapular artery is the largest branch of the axillary artery.
The subscapular artery originates from the medial surface of the third part of the axillary artery. It passes along the inferior border of the subscapularis muscle and it divides into two branches 1,2:
The axillary artery represents the continuation of the subclavian artery and is a major artery of the upper limb.
origin: continuation of the subclavian artery as it passes under the midpoint of the clavicle on the outer edge of the first rib
termination: continues as the brachial ar...
The subcostal arteries are bilateral small arteries that arise of the distal descending aorta which courses laterally beneath the 12th rib. They are the last
The subcostal arteries are analogous to the posterior intercostal arteries, instead in the subcostal space rather than an...
Thoracic aortic injury is the most common type of traumatic aortic injury and is a critical life-threatening, and often life ending event. It can result from either blunt or penetrating trauma:
blunt trauma (more common)
rapid deceleration (eg. motor vehicle accident, fall from great height)
The staging system for moyamoya disease first described by Suzuki and Takaku in their seminal 1969 article1 is still in use today. Formally, the staging refers to findings on conventional angiography, although there are efforts to apply similar systems to MR angiography.2
Suzuki stage appears t...
Blue rubber bleb nevus syndrome (BRBNS) or Bean syndrome, is a rare sporadic syndrome characterised by multifocal venous anomalies. Patients often have multiple soft blue skin lesions associated with multiple bowel venous malformations, which could lead to lower gastrointestinal bleeding.
Westermark sign is a sign of pulmonary embolus (PE) seen on chest radiographs.
Along with Fleishner sign and Hampton hump, it makes one of the three described signs of pulmonary embolus on chest radiographs.
In one study (PIOPED) this sign was present on ~10% of chest x-rays of pati...
Vena cava filter is an endovascular device which is typically placed in the infrarenal inferior vena cava (IVC) to prevent pulmonary embolism in selected patients. This procedure is most often performed by interventional radiologists under fluoroscopic guidance.
The diaphragm is the dome-shaped muscle that separates the thoracic cavity from the abdominal cavity, enclosing the inferior thoracic aperture.
The muscular fibres of the diaphragm originate around the circumference of the inferior thorax and converge to a common insertion point ...
A fetal (origin of the) posterior cerebral artery is a common variant in the posterior cerebral circulation, estimated to occur in 20-30% of individuals 2.
The posterior communicating artery (PCOM) is larger than the P1 segment of the posterior cerebral artery (PCA) and supplies the bulk of the...
The lumbar arteries are paired branches of the abdominal aorta arising in the lumbar region.
There are most commonly four paired lumbar arteries originating as posterolateral branches of the abdominal aorta on either side, at the level of L1-4.
The paired arterie...
The intercostal spaces are supplied by pairs of anterior and posterior intercostal arteries.
The first two intercostal spaces are supplied by the superior intercostal artery, and the remaining nine are supplied by separate branches from the descending thoracic aorta 1. The right ...
The pampiniform plexus is the venous network of approximately 10 veins draining the testes and epididymis. The network surrounds the testicular artery in the spermatic cord and lies anterior to the ductus deferens. Each network coalesces to form the testicular veins.
Along with the cremaster an...
Double aortic arch is the most common symptomatic type of the aortic arch variant. It may account for up to 50-60% of vascular rings.
Double aortic arch is mostly diagnosed in childhood due to of symptoms related to oesophageal and/or tracheal obstruction. Respiratory sym...
Nutcracker syndrome is a vascular compression disorder and refers to the compression of the left renal vein between the superior mesenteric artery (SMA) and aorta. This can lead to renal venous hypertension, resulting in rupture of thin-walled veins into the collecting system with resultant haem...
The superficial femoral artery is a continuation of the common femoral artery at the point where the profunda femoris branches. It is the main artery of the lower limb and is, therefore, critical in the supply of oxygenated blood to the leg.
origin: continuation of the common femoral a...
Aortic intramural haematoma (IMH) is an atypical form of aortic dissection due to haemorrhage into the wall from the vasa vasorum without an intimal tear. It is part of the acute aortic syndrome spectrum.
Typically aortic intramural haematomas are seen in older hypertensive patien...
Penetrating atherosclerotic ulcers (PAU) is a pathology that involves the aortic wall and along with aortic dissection and aortic intramural haematoma form the spectrum known as acute aortic syndrome.
Typically, penetrating atherosclerotic ulcers are seen in older male patients w...
Aortoenteric fistula is an uncommon catastrophic cause of gastrointestinal haemorrhage. Aortic fistulas can be primary (associated with complicated abdominal aortic aneurysm) or secondary (associated with graft repair).
The annual incidence of primary aortoenteric fistulas is thou...
Cervical aortic arch is a rare aortic arch anomaly characterised by an elongated, high-lying aortic arch extending at or above the level of the medial ends of the clavicles.
Patients with cervical aortic arch are usually asymptomatic. Symptomatic patients may present with...
The profunda femoris artery (also known as the deep femoral artery or deep artery of thigh) is a branch of the common femoral artery and is responsible for providing oxygenated blood to the deep structures of the thigh, including the femora.
origin: common femoral artery
Minimal aortic injuries are traumatic aortic lesions that usually involve the intima and are recognised more frequently due to the use of high-resolution imaging.
Minimal aortic injuries account for 10-28% of all blunt traumatic aortic injuries 1,6,7. The proportion of this type o...
Aortic pseudoaneurysms typically occur as a result of trauma, a subset of traumatic aortic injury. They can be acute or chronic.
Aortic pseudoaneurysms are contained ruptures of the aorta in which the majority of the aortic wall has been breached, and luminal blood is held in only by...
A persistent sciatic artery is a rare vascular anomaly where there is the continuation of the internal iliac artery into the thigh through the greater sciatic notch. It may be the dominant artery supplying the leg, in which case the superficial femoral artery may be small.
Retinal Vasculopathy with Cerebral Leukoencephalopathy and Systemic manifestations (RVCL-S) is an autosomal dominant microvasculopathy of the brain, retina, and other organ systems.
RVCL-S was described by Stam and colleagues in 2016 to encompass several previously described condit...
Superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome, is a rare acquired vascular compression disorder in which acute angulation of superior mesenteric artery (SMA) results in compression of the third part of the duodenum leading to obstruction.
It should not be confused wit...
Cavernous transformation of the portal vein (CTPV) is a sequela of portal vein thrombosis and is the replacement of the normal single channel portal vein with numerous tortuous venous channels.
For a discussion of demographics and presentation, please refer to the article on portal vein thrombo...
COL4A1-related disorders are a group of autosomal dominant disorders caused by a mutation in the COL4A1 gene.
The exact prevalence is unknown, but the group of disorders is considered to be under-recognised, especially asymptomatic variants 1.
The clinical ...
Variant anatomy of the aortic arch occurs when there is failure of normal aortic development. It results in a number of heterogenous anomalies of the aorta and its branch vessels.
Normally, the aorta ascends in the superior mediastinum to the level of the sternal notch before arc...
SVC & IVC - variants
Intracranial arteries - variants
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is an autosomal dominant microvasculopathy, characterised by recurrent lacunar and subcortical white matter ischaemic strokes and vascular dementia in young and middle age patients without known ...
The fibular or peroneal artery is one of the three arteries of the leg, along with the anterior and posterior tibial arteries.
Origin and course
arises from the tibioperoneal trunk approximately 2.5 cm distal to popliteus and passes obliquely to the fibula, descending along its ...
Coral reef aorta (CRA) is a rare disease, described as rock-hard calcifications involving the arterial wall which protrude into the lumen. It predominantly involves the posterior thoracic and abdominal aorta. CRA luminal lesions can cause significant aortic stenosis.
Aortic ductus diverticulum is a developmental outpouching of the thoracic aorta.
It is usually seen at the anteromedial aspect of the aorta at site of the ligamentum arteriosum, at the aortic isthmus. This is also the site of 90% of post-traumatic aortic injuries as the ligamentu...
Getting a film with traumatic aortic injury in the exam is one of the many exam set-pieces that can be prepared for.
This is one of the cases you should look and not speak for 10 seconds as there tends to be a lot of findings on the film of patients with traumatic aortic injury.
Abdominal aortic injuries are a very rare form of traumatic aortic injury and are much less common than thoracic aortic injury.
Aortic injury occurs in <1% of blunt trauma patients, with abdominal aortic injury representing only ~5% of all aortic injuries 1. Males are more freque...
Traumatic aortic injury (TAI) is most often caused by blunt trauma (refered to as BTAI) and is best described in terms of injury location, type and and severity:
abdominal aortic injury
thoracic aortic injury
minimal aortic injury
See traumatic aortic injury in the exam.