Fukuda Kodai, Sonomura Tetsuo, Higashino Nobuyuki, Nishioka Naoki, Sato Hirotatsu, Ikoma Akira, Kitahara Chie, Takeshima Ken, Matsuoka Takaaki, Funayama Yuya, Murotani Kazuhiro, Minamiguchi Hiroki
Department of Radiology, Wakayama Medical University, Wakayama, Japan.
First Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Radiol Case Rep. 2025 Aug 6;20(11):5387-5390. doi: 10.1016/j.radcr.2025.07.010. eCollection 2025 Nov.
Primary aldosteronism is the most common cause of secondary hypertension. Adrenal vein sampling (AVS) is a diagnostic procedure to determine whether aldosterone hypersecretion is unilateral or bilateral, and thereby guide the choice of adrenalectomy or pharmacotherapy as the appropriate treatment. However, during AVS, it is challenging to cannulate the right adrenal vein (RAV) owing to its anatomical variability and poor visibility on preoperative CT. This case report describes the successful use of intraoperative 4D-CT angiography from the right adrenal artery to identify the RAV opening, which was invisible on preoperative contrast-enhanced CT. The patient, a woman in her 40s with primary aldosteronism and a right adrenal nodule, underwent 4D-CT because the RAV could not be located by conventional preoperative CT. The intraoperative 4D-CT clearly visualized the RAV and contrast material ascending along the right wall of the inferior vena cava. These images were then fused onto live fluoroscopy to guide a catheter into the RAV. The AVS indicated bilateral aldosterone hypersecretion, and the patient was managed pharmacologically. Intraoperative 4D-CT angiography from the right adrenal artery can increase the success rate of AVS, especially in difficult cases where the RAV is invisible on preoperative CT.
原发性醛固酮增多症是继发性高血压最常见的病因。肾上腺静脉采血（AVS）是一种诊断方法，用于确定醛固酮分泌过多是单侧还是双侧，从而指导选择肾上腺切除术或药物治疗作为合适的治疗方法。然而，在AVS过程中，由于右肾上腺静脉（RAV）的解剖变异以及术前CT上显示不清，要将导管插入RAV具有挑战性。本病例报告描述了成功使用术中从右肾上腺动脉进行的4D-CT血管造影来识别RAV开口，该开口在术前增强CT上不可见。该患者为一名40多岁患有原发性醛固酮增多症和右肾上腺结节的女性，因常规术前CT无法定位RAV而接受了4D-CT检查。术中4D-CT清晰地显示了RAV以及造影剂沿下腔静脉右壁上行。然后将这些图像与实时荧光透视融合，以引导导管进入RAV。AVS显示双侧醛固酮分泌过多，该患者接受了药物治疗。术中从右肾上腺动脉进行的4D-CT血管造影可以提高AVS的成功率，尤其是在术前CT上RAV不可见的困难病例中。
