Fukuda Kodai, Sonomura Tetsuo, Higashino Nobuyuki, Mimura Ryosuke, Koyama Takao, Ikoma Akira, Sakane Daiki, Tsuji Tomoya, Matsuoka Takaaki, Minamiguchi Hiroki
Department of Radiology, Wakayama Medical University, Wakayama, Japan.
Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Radiol Case Rep. 2024 Jul 31;19(10):4435-4439. doi: 10.1016/j.radcr.2024.07.003. eCollection 2024 Oct.
A male patient in his forties was diagnosed with primary aldosteronism following blood tests. The patient requested surgical treatment and was transferred to our department for adrenal vein sampling. Preoperative contrast-enhanced computed tomography (CT) revealed that the left adrenal vein (LAV) did not form a common trunk with the left inferior phrenic vein, and instead drained into both the left renal vein (LRV) and inferior vena cava (IVC) after the bifurcation. Angiography from the LAV showed a branch draining into the IVC. Left-sided sampling was performed. Aldosterone levels were elevated at all 3 sites. Because the sampling results were bilaterally positive, the patient was contraindicated for surgery. There are no reports of an anomalous LAV draining into both the LRV and IVC, making this case extremely unique. Regarding the LAV sampling site, it has been reported that aldosterone levels are higher in the common trunk than in the LAV. Therefore, we increased the number of blood sampling sites. In adrenal vein sampling, we often focus on the anatomy of the right adrenal vein because of difficulties in accessing to it. However, anomalies of the LAV may also occur. Therefore, it is important to determine the anatomy of both adrenal veins using preoperative contrast-enhanced CT to plan an appropriate sampling strategy.
一名四十多岁的男性患者经血液检查后被诊断为原发性醛固酮增多症。患者要求手术治疗，并被转至我科进行肾上腺静脉采血。术前增强计算机断层扫描（CT）显示，左肾上腺静脉（LAV）未与左膈下静脉形成共同主干，而是在分叉后汇入左肾静脉（LRV）和下腔静脉（IVC）。从LAV进行的血管造影显示有一分支汇入IVC。进行了左侧采血。所有3个部位的醛固酮水平均升高。由于采血结果双侧呈阳性，该患者不适合手术。目前尚无LAV异常汇入LRV和IVC的报道，因此该病例极为独特。关于LAV采血部位，有报道称共同主干中的醛固酮水平高于LAV中的水平。因此，我们增加了采血部位的数量。在肾上腺静脉采血中，由于右肾上腺静脉难以穿刺，我们常常关注其解剖结构。然而，LAV也可能出现异常。因此，利用术前增强CT确定双侧肾上腺静脉的解剖结构以制定合适的采血策略非常重要。
