A mobilised abdominal part from a 60-year-old, formalinfixed female cadaver was dissected during ... more A mobilised abdominal part from a 60-year-old, formalinfixed female cadaver was dissected during a routine anatomy dissection laboratory session. Grant's Dissector Manual was used as a reference during the dissection process, and digital images were taken of the entire dissected area. The kidneys are paired retroperitoneal organs situated in the renal fossa, on the posterior abdominal wall level with the T12 to L3 vertebrae. Each kidney is surrounded by three layers, as well as a partial fourth layer that furnishes a bed of fat posterior to each kidney [1]. The first layer, known as the fibrous capsule, attaches directly to the body of the kidney. The second layer is the perinephric fat capsule, or adipose capsule. The third layer, of most concern to us in this article, is the renal fascia or Gerota's fascia, which is made up of collagenous connective tissue [2]. Gerota's fascia surrounds the kidney, fusing laterally and medially to the body of the kidney, and superiorly to the adrenal glands. It is not fused inferiorly, however; this means that fluid may accumulate down the flank of the kidney whilst not being present in the perinephric space surrounding the kidney [3]. The significance of this fascia is that it separates the kidneys from other structures such as the abdominal aorta, inferior vena cava, and renal arteries and veins. A common misunderstanding exists due to the frequent use, in medical literature, of the term "Gerota's fascia" to describe both the anterior and posterior pararenal fascia. To further compound this misunderstanding, the term "Zuckerkandl's fascia" has also been used to refer to either the anterior or posterior fascia. To clear up the confusion, Chesbrough RM et al. reviewed the original papers of both Gerota and Zuckerkandl. They discovered that, while Zuckerkandl characterised the posterior renal fascia in 1883, his study made no mention of the anterior renal fascia. In 1895, Gerota firmly assigned Zuckerkandl's name to the posterior renal fascia, while also confirming the existence of the anterior renal fascia [4]. Gerota's research has led to the interchangeable use of the terms "Zuckerkandl's fascia" and "posterior renal fascia" to describe the same anatomical structure. Likewise, the terms "Gerota's fascia" and "anterior renal fascia", which refer to the same fascial layer, are also interchangeable [4].
The median artery is a transient embryological structure that normally disappears with the develo... more The median artery is a transient embryological structure that normally disappears with the development of the radial and ulnar arteries. In rare instances, though, it persists as the persistent median artery (PMA). The superficial and deep palmar arches are formed through the anastomoses of the radial and ulnar arteries, giving hand and digits their main blood supply. This complex network of vessels and their anastomoses are prone to anatomical variations based on how the anastomosis occurs and which arteries contribute to this anastomosis. While it normally forms through the anastomosis of the radial and ulnar arteries, the superficial palmar arch (SPA) may also form differently, as in our case here, where the median artery persisted and branched off the radial artery, anastomosing with the ulnar artery to give rise to the SPA. This may also interfere with the normal compartmental architecture within the hand, possibly contributing to various clinical pathologies like carpal tunnel syndrome (CTS). Notably, in addition to the persistent median artery, our findings revealed a reversed palmaris longus and a bifid median nerve. These two additional variations can potentially exacerbate the risk of CTS. Alone, the coexistence of the PMA and the reversed palmaris longus is deemed a rare anomaly, only reported once in the literature. The addition of a third variation to the existing ones, like the bifid median nerve, is first reported by us and calls for more investigation for a possible genetic mutation. In this case, we report a persistent median artery, reversed palmaris longus muscle, and bifid median nerve in the forearm of a male cadaver found during a routine anatomy teaching session.
Anatomy is a vital basic science for safe and effective medical practice and its significance inc... more Anatomy is a vital basic science for safe and effective medical practice and its significance increases several folds when it is taught in a clinically relevant manner. In today's time-compressed modern medical curricula, the importance of dissection-based anatomy programs is integral to teaching–learning outcome. Sound anatomical knowledge is critical to safe clinical and surgical practice as it is fundamental to the career of future doctors. In this pictorial essay, we present a case of a left ectopic pelvic kidney during one of the faculty-guided dissection sessions at the Alfaisal University. Such an anomaly motivated students to perform further meticulous dissection and to engage in detailed discussions after identifying associated abnormal findings. It is believed that these practices at the very start of the medical journey of students will effectively enhance their clinical reasoning skills by integrating basic and clinical anatomy.
A mobilised abdominal part from a 60-year-old, formalinfixed female cadaver was dissected during ... more A mobilised abdominal part from a 60-year-old, formalinfixed female cadaver was dissected during a routine anatomy dissection laboratory session. Grant's Dissector Manual was used as a reference during the dissection process, and digital images were taken of the entire dissected area. The kidneys are paired retroperitoneal organs situated in the renal fossa, on the posterior abdominal wall level with the T12 to L3 vertebrae. Each kidney is surrounded by three layers, as well as a partial fourth layer that furnishes a bed of fat posterior to each kidney [1]. The first layer, known as the fibrous capsule, attaches directly to the body of the kidney. The second layer is the perinephric fat capsule, or adipose capsule. The third layer, of most concern to us in this article, is the renal fascia or Gerota's fascia, which is made up of collagenous connective tissue [2]. Gerota's fascia surrounds the kidney, fusing laterally and medially to the body of the kidney, and superiorly to the adrenal glands. It is not fused inferiorly, however; this means that fluid may accumulate down the flank of the kidney whilst not being present in the perinephric space surrounding the kidney [3]. The significance of this fascia is that it separates the kidneys from other structures such as the abdominal aorta, inferior vena cava, and renal arteries and veins. A common misunderstanding exists due to the frequent use, in medical literature, of the term "Gerota's fascia" to describe both the anterior and posterior pararenal fascia. To further compound this misunderstanding, the term "Zuckerkandl's fascia" has also been used to refer to either the anterior or posterior fascia. To clear up the confusion, Chesbrough RM et al. reviewed the original papers of both Gerota and Zuckerkandl. They discovered that, while Zuckerkandl characterised the posterior renal fascia in 1883, his study made no mention of the anterior renal fascia. In 1895, Gerota firmly assigned Zuckerkandl's name to the posterior renal fascia, while also confirming the existence of the anterior renal fascia [4]. Gerota's research has led to the interchangeable use of the terms "Zuckerkandl's fascia" and "posterior renal fascia" to describe the same anatomical structure. Likewise, the terms "Gerota's fascia" and "anterior renal fascia", which refer to the same fascial layer, are also interchangeable [4].
The median artery is a transient embryological structure that normally disappears with the develo... more The median artery is a transient embryological structure that normally disappears with the development of the radial and ulnar arteries. In rare instances, though, it persists as the persistent median artery (PMA). The superficial and deep palmar arches are formed through the anastomoses of the radial and ulnar arteries, giving hand and digits their main blood supply. This complex network of vessels and their anastomoses are prone to anatomical variations based on how the anastomosis occurs and which arteries contribute to this anastomosis. While it normally forms through the anastomosis of the radial and ulnar arteries, the superficial palmar arch (SPA) may also form differently, as in our case here, where the median artery persisted and branched off the radial artery, anastomosing with the ulnar artery to give rise to the SPA. This may also interfere with the normal compartmental architecture within the hand, possibly contributing to various clinical pathologies like carpal tunnel syndrome (CTS). Notably, in addition to the persistent median artery, our findings revealed a reversed palmaris longus and a bifid median nerve. These two additional variations can potentially exacerbate the risk of CTS. Alone, the coexistence of the PMA and the reversed palmaris longus is deemed a rare anomaly, only reported once in the literature. The addition of a third variation to the existing ones, like the bifid median nerve, is first reported by us and calls for more investigation for a possible genetic mutation. In this case, we report a persistent median artery, reversed palmaris longus muscle, and bifid median nerve in the forearm of a male cadaver found during a routine anatomy teaching session.
Anatomy is a vital basic science for safe and effective medical practice and its significance inc... more Anatomy is a vital basic science for safe and effective medical practice and its significance increases several folds when it is taught in a clinically relevant manner. In today's time-compressed modern medical curricula, the importance of dissection-based anatomy programs is integral to teaching–learning outcome. Sound anatomical knowledge is critical to safe clinical and surgical practice as it is fundamental to the career of future doctors. In this pictorial essay, we present a case of a left ectopic pelvic kidney during one of the faculty-guided dissection sessions at the Alfaisal University. Such an anomaly motivated students to perform further meticulous dissection and to engage in detailed discussions after identifying associated abnormal findings. It is believed that these practices at the very start of the medical journey of students will effectively enhance their clinical reasoning skills by integrating basic and clinical anatomy.
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