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SOME VASCULAR ANOMALIES OBSERVED DURING 
 "*" THE SESSION 1888-89. By Francis J. Shepherd, 
 
 M.D., Professor of Anatomy in M'Gill University, 
 
 Montreal. 
 
 The following anomalies, which are of some rarity, I have 
 thought of sufficient interest to be placed on record : — 
 
 I. Right Subclavian Artery arising from the Descending 
 Aortic Arch — Right Vertebral Artery given of from the 
 Common Carotid — Right Pulmonary Vein emptying into 
 the Vena Azygos Major — Absence of the Levator Ani Muscle. 
 
 The subject in which these anomalies occurred died of phthisis in 
 the General Hospital, aged 30. She never had any difficulty in 
 swallowing, nor was she left-handed. There was well-marked rickety 
 deformity of the bony thorax and other parts of the skeleton. 
 
 The right subclavian artery arose from the posterior part of the 
 aortic arch, opposite the 3rd dorsal vertebra, passed obliquely upwards 
 over the dorsal vertebrae to the root of the neck on the right side. 
 In its coiirse it went behind the trachea and oesophagus. There was, 
 of course, no innominate artery, the right common carotid arising 
 directly from the transverse arch. The right vertebral arose from 
 the right common carotid at the point where the s\ibclavian is usually 
 given off from the innominate ; it passed up the neck to enter the 
 transverse process of the 4th cervical vertebra. The left vertebral 
 arose from the transverse arch between the left common carotid and 
 left subclavian, and entered the transverse process of the 3rd cervical 
 vertebra. The right inferior laryngeal nerve turned around the right 
 vertebral artery instead of the subclavian. The right sympathetic 
 was divided into two cords, which embraced the abnormal subclavian ; 
 the superficial cord hooked round the lower part of the artery to join 
 its fellow. This was mistaken at first by the student dissecting the 
 part for the recurrent laryngeal nerve. 
 
 The explanation of this anoinaly is well recognised, and has 
 been described by Rathke, Wood, Turner, and others. It is an 
 example of persistence of the right aortic root. The fourth 
 arch, from which the subclavian of the right side is usually 
 derived, having atrophied and partially disappeared — that is, 
 the portion external to the origin of the vertebral. The verte- 
 bral, then, would represent the shortened fourth arch, and the 
 part of the carotid, as far as the vertebral, the innominate. This 
 
70 
 
 PROFESSOR FRANCIS J. SHEPHERD. 
 
 would explain why the right inferior laryngeal nerve recurved 
 around the vertebral artery instead of the subclavian. 
 
 In the same subject, on the right side, there was but one pulmonary 
 vein. This was of large size, and, in place of emptying into the left 
 auricle, it joined the vena azygos major just before it arched over the 
 root of the right lung. The combined veins emptied into the superior 
 cava. Unfortunately, I only saw this specimen when the heart was 
 in a mutilated "onditiou, and hence could not satisfactorily examine 
 that organ. A part of the blood going to the right lung would have 
 a very small circuit, viz., from the superior cava to right auricle, 
 thence into the right ventricle through the pulmonary artery to the 
 lungs, then back again to the superior cava by the right pulmonary 
 vein, and so on. Thus aerated blood would be continually passing 
 into the venous circulation. 
 
 In the same subject the kidneys were supplied by several arteries. 
 The obturator arteries were given off from the epigastrics, and, on the 
 right side, the lingual and facial arose by a single trunk, while on the 
 left side the lingual and superior thyroid arose together. The teeth 
 were very irregular and badly formed, and the superior maxillse 
 proper distinctly overlapped the inter-maxillary bones. 
 
 I might add that in this remarkable subject no trace could be found 
 of the levator ani muscle ; its place was taken by pelvic fascia. 
 
 II. Absence of the Rigid Inferior Thyroid Artery, its place 
 being taken by a large branch from the Innominate — Origin 
 of Left Inferior Thyroid from the Left Common Carotid. 
 
 This arrangement of the thyroid arteries in the same subject is so 
 rare that, as far as I am aware, no similar case has ever been reported. 
 Two branches only were given off from the transverse arch of the 
 aorta, the innominate and left subclavian. The left carr-^id was a 
 branch of the innominate. Near the bifurcation of the innominate 
 a large branch was given off, which crossed the trachea and coursed 
 up its left border to supply the lower part of the left lobe of the 
 thyroid gland. As it crossed the trachea it gave off a small branch 
 which ascended the trachea to the gland. This abnormal artery 
 would have been much in the way in performing the operation of 
 tracheotomy. 
 
 The right inferior thyroid was a branch of the common carotid 
 three quarters of an inch from its origin ; it was of large size, and 
 passed directly up to the right lobe of the thyroid gland. There was 
 no thyroid artery given off from either subclavian artery ; the other 
 branches of the axis were given off separately. All four thyroid 
 arteries were of large size. 
 
 The absence of the left thyroid may be explained by the fact that 
 the anastomotic branches between the middle thyroid and the left 
 inferior thyroid enlarged abnormally, and in consequence there was a 
 diminution and afterwards a disappearance of the normal inferior 
 thyroid. 
 
SOME VASCULAR ANOMALIES. 
 
 71 
 
 In tho same subject, from the first part of the right subclavian 
 artery, a hirge branchial artery was given otf', wliich jjassed down 
 behin'i tho aortic arch to roach tho bifurcation of tho trachea. I 
 have several times seen this artery ; on one occasion it reached the 
 descending aorta with which it communicated, and I looked upon it as 
 a persistence of the right aortic root. 
 
 III. Double Inferior Cava. 
 
 In this case tho external and internal iliac veins of each side 
 imited to form a conmion iliac vein. Tho left vein passed up on 
 tho left side of the aorta and joined the left renal vein, the right 
 iliac vein took the usual position of tlio inferior cava. These 
 cases are not very uncommon, and I have scon quite a number of 
 examples of this anomaly. Frequently there is a large transverse 
 branch between the two iliacs. These cases of double inferior cava 
 are examples of the persistence of the lower part of tho cardinal 
 veins. 
 
 IV. Misplaced Left Kidney with Ahnormcd Blood Supply, 
 
 In this case the misplaced kidney was situated between the two 
 comiTion iliac arteries. The hilus was placed anteriorly in the centre 
 of the kidney, which was small and of an irregular discoid shape. It 
 received its blood supply from a large artery which came off from the 
 aorta at its bifurcation. The left renal vein emptied into the left com 
 mon iliac and received the left spermatic. The left supra-renal capsule 
 retained its normal position, and was of large size ; it received its 
 blood supply from the left spermatic artery. A similar case was 
 reported in the January (1889) number of this Journal by Dr R. B. 
 Mahon. 
 
 V. Multiple Renal Arteries and Veins. 
 
 In this subject both kidneys were placed at a lower level than 
 normal, and reached to the intervertebral substancfe between the 4th 
 and 5tli lumbar vertebra3. The hilus of each kidney Avas situated in 
 front. The right kidney had thi-ee veins going from the hilus to join 
 the vena cava. The left renal vein was of large size and divided into 
 two branches, one of which passed beneath the aorta. A vein of some 
 size united it to the left common iliac ^ vein, whilst another still larger 
 passed for the branch which went over the aorta to the splenic vein. 
 Each kidney, in addition to its normal artery entering the hilus from 
 the aorta, received a bi-anch at its extreme lower end from the common 
 iliac artery of that side. 
 
 Note. — All the anomalies above described are in the Anatomical 
 Museum of M'Gill University. 
 
 ^ This was probably tlie remains of the lower part of the left cardinal vein.