Axillary arch: a unique entity

Abstract

showed a left central-type facial palsy. The patient's left extremities were weak, with muscle power grade 3 in the upper limbs and grade 4 in the lower limbs. Laboratory examination revealed no abnormalities in the serum hypercoagulable panel. Electrocardiography revealed normal sinus rhythm without arrhythmia. Computed tomography and magnetic resonance imaging ( Fig. 1) confirmed the presence of a calcified tumour in the right and medial portion of the sphenoid ridge. The tumour compressed the first segment of the middle cerebral artery (MCA), thereby resulting in an acute thromboembolic MCA territory infarct. To prevent morbidity secondary to vascular injury, the patient underwent Simpson grade III resection through the pterional approach. The tumour was adherent to the surrounding frontal lobe and vessels, and the arachnoid membrane was not preserved. The vessel compression was resolved, but the hemiparesis persisted. The pathology revealed a psammomatous meningioma. After a 3-month rehabilitation programme, the patient recovered with mild paresis in the left upper extremity.Meningioma could result in acute infarction of the MCA as in the case of ICA and anterior cerebral artery. 1,2 We suspect that hypoperfusion resulted from external compression by the meningioma, and artery-to-artery thromboembolization contributed to the pathophysiology of our patient's hemiparesis. We also want to emphasize that in patients with acute infarction, the possibility of sphenoid ridge meningioma must be considered in the differential diagnosis.

Axillary Arch May Affect Axillary Lymphadenectomy

“…Langer's axillary arch has been implicated in concealing level I lymph nodes in axillary dissection and thereby resulting in erroneous supra-axillary dissection [3,4,6]. Additionally, the risk of neurovascular compression leading to postoperative upper limb lymphedema and thoracic outlet syndrome has also been described [1,2,3,4,7]. This compression has been noted particularly during abduction or external rotation of the arm [1,7].…”

“…This compression has been noted particularly during abduction or external rotation of the arm [1,7]. Compression of the brachial plexus, particularly of the median nerve, and the contribution from the medial and lateral cords is a known risk [2,4]. With regards to hemodynamic compromise, 1 study noted no change in hemodynamic parameters in the arteries but compression of venous blood flow with compensatory increased blood velocity [7].…”

“…With regards to hemodynamic compromise, 1 study noted no change in hemodynamic parameters in the arteries but compression of venous blood flow with compensatory increased blood velocity [7]. The axillary arch muscle also has been also associated with major thrombosis of the upper extremities [2.] Thus, awareness of the possible complications of an axillary arch muscle and the understanding that this muscle anomaly is not functionally significant demonstrate that this muscle group can be cut without any functional deficit [1].…”

“…This axillary region generally contains the neurovascular bundle, many lymph nodes and vessels, and lateral branches of the axillary nerves [1]. Additionally, several anatomic variations may be present, and awareness of such variations and their features is essential for completing axillary surgery with better outcomes [2]. The most common anatomical anomaly in the axillary region is the presence of an axillopectoral muscle, also known as Langer's axillary arch.…”

Evidence of increased axillary blood flow velocity without increased handgrip strength and endurance in persons with a fibromuscular axillary arch

“…Although its structure (muscular or fibrous), its course and insertion site can be visualised using medical imaging such as computed tomography and magnetic resonance imaging, detailed ultrasonographic descriptions are scarce [12]. Clinically and physiologically, the AA has been implicated in thoracic outlet syndrome, and associated sensory and motor strength changes [3,21,25]. The neurovascular bundle is supposed to be most strongly compressed by stretching the AA with the arm in abduction and external rotation.…”