International Journal of Current Research and Review (IJCRR)

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IJCRR - Vol 06 Issue 21, November

Pages: 15-17

Date of Publication: 11-Nov-2014


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A RARE FINDING OF THYROID IMA ARTERY ARISING FROM THE AORTIC ARCH WITH
ABSENCE OF LEFT INFERIOR THYROID ARTERY: A CASE REPORT

Author: Takkallapalli Anitha

Category: Healthcare

Abstract:An anomalous artery was seen arising from the arch of aorta and coursed upwards to the isthmus of thyroid gland. In the same cadaver, on further exposure of blood vessels supplying the thyroid gland, it is observed that the left inferior thyroid artery was absent. Though the incidence of thyroid ima artery arising from brachio cephalic trunk and subclavian artery was reported earlier, this is a rare finding where the artery arose from arch of aorta with absence of left inferior thyroid artery.

Keywords: Blood supply of thyroid, Inferior thyroid artery, Arch of aorta

Full Text:

INTRODUCTION
Arteria thyroidea ima is a small, inconstant but important artery of thyroid gland. In addition to thyroid, the artery may also supply the thymus gland and neck viscera [1]. It is present in 3% of cases and when present, it emerges from brachio cephalic trunk, the arch of Aorta, the subclavian artery, right common carotid artery or internal mammary artery [2]. Krudy et al stated that an additional midline artery to the thyroid posing a threat in cervico surgical operations was first described by Neubauer in 1772 and so was named Neubauers artery [3]. Hollishead (1962) described an accessory artery replacing the inferior thyroid artery as thyroid ima artery [4]. The knowledge of thyroid ima artery plays a significant role in neck surgeries [5].

CASE REPORT
The thyroid ima artery in this case report was observed in an embalmed adult male cadaver, aged 53 years, during routine dissection in the department of Anatomy at Chalmeda Anand Rao Institute of Medical Sciences, Bommakal , Karimnagar. During the neck dissection, an anomalous artery was observed in front of trachea, ascending upwards to reach the isthmus of thyroid gland. On further exposure of thorax and tracing the artery to its origin, it was noticed that this slender artery arose from the upper margin of arch of aorta and coursed towards isthmus without giving any branches. On further dissection to expose the blood vessels of thyroid gland, it is observed that the inferior thyroid artery on the left side was absent. The right inferior thyroid artery had normal origin and course.

DISCUSSION
The thyroid ima artery is the inconstant third artery that supplies blood to the isthmus of the thyroid gland. The calibre of thyroid ima artery may be as large as the inferior thyroid artery or merely a small twig. A review of literature shows marked degree of variability in the frequency, the site of origin and the size of thyroid ima artery. The incidence varies from 1.5 to 12’2% [6]. The commonest site of origin of the thyroid ima artery is from the innominate artery [1.9 to 6%] followed by right common carotid artery in 1.4% to 1.7 % [7]; from the arch of aorta on left side in 0.36 %[4] . Bilateral thyroid ima arteries have been reported by Gruber. [7]. Faller et al observed that in 60% of 100 sides that they investigated and reported, the incidence of absence of inferior thyroid artery has been 0.20% to 5.9 % When an inferior thyroid artery is absent, its place is usually taken by a branch of superior thyroid artery of same side or the inferior thyroid artery of other side or is taken by thyroid ima artery [6].The present study coincides with the above observation.

Phylogenitically, the thyroid gland has a rich network of nutrient vessels. During development many vessels disappear except the superieor and inferior thyroid arteries, persistirng as the regular supply. Occasionally a part of the original vascular network connecting the brachiocephalic, the arch of aorta and carotids may persist and by fusion may either supplement or substitute for the regular arteries as the thyroid ima arterty. [8]

CLINICAL SIGNIFICANCE
The knowledge of the course of the thyroid ima artery is important for surgeons while performing neck surgeries or during tracheostomy procedures [9] . Atypical branching of vessels can cause intraoperative bleeding and /or post operative hematoma by damaging the thyroid ima artery [10]. The knowledge of this artery is necessary in angiography done as a preoperative requisite in the thyroid and parathyroid surgeries, which could be missed if this artery is not selectively injected.

CONCLUSION
The thyroid ima artery cannot be undermined in clinical practice as per its vulnerability to be accidentally cut or injured during tracheostomies or mediastinoscopy leading to uncontrollable haemorrhage.

ACKNOWLEDGEMENTS
Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to author/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

1. Kimmel DL: Anterior mediastinal origin of the thyroidea ima artery. Anatomical Records, 1949; 103: 544 Abst No:270.

2. Chummy S. Sinnatamby. Last’s anatomy, regional and applied Churchill living stone. 11th ed. 2006; P 352.

3. Krudy AG, Doppman JL, Brennan F: The significance of the thyroid ima artery in angiographic localization of parathyroid adenomas Radiology, 1980; 136: 51-55.

4. Hollinshead WH; Head and Neck In: Anatomy for surgeons (vol.1). 1st edn. Hober and Harper, Newyork, 1962: PP: 520-533.

5. Nanka O, Sedy J, Vitkova I , Libansky P, Adamek S.Surgical anatomy of parathyroid gland with emphasis on parathyroidectomy. Prague Med. Rep. 2006; 107: 261-272.

6. Faller A, Scharer O: Uber die variabilitat der arteriae thyroideae. Acta Anatomica, 1947; 4: 119-122.

7. Gruber W. Ueber die thyroidea ima Archives of pathology Anatomic und physiologie u Klin medicine. 1872; 54: 445- 484. Cited by Krudy et al (1980) vide infra.

8. K. Dharwal: The thyro thymic trunk – A collateral vessel to the thyroid and the thymus: People’s journal of scientific research vol.2(2), July 2009: 31-33.

9. Yilmaz E, Celik H H, Durgun B, Atasever A, Ilgi S. Arteria thyroidea ima arising from the brachiocephalic trunk with bilateral absence of inferior thyroid arteries: a case report. Surg. Radiol Anat: 1993: 15: 197-199.

10. Carty SE. Prevention and management of complication in parathyroid surgery. Otolaryngol. Clin. North Am. 2004; 37: 897-907.