IMAGES IN IR
Variant Adrenal Vein Anatomy: Free with Sample Sindhura Nirmalarajan, BMed, Alan Dackiw, MD, PhD, and Mark L. Lessne, MD
A 54-year-old man with primary hyperaldosteronism presented for adrenal vein sampling. Computed tomography performed before the procedure (a) suggested variant right adrenal vein (RAV) anatomy (solid arrow) as a shared confluence with an inferior accessory hepatic vein (dotted arrow). Venography performed during selective adrenal vein sampling (b) demonstrated the confluent anatomy of the RAV (solid arrow) and inferior accessory hepatic vein (dotted arrow). RAV selectivity was subsequently confirmed by laboratory analysis. During laparoscopic adrenalectomy (c), the RAV was not visualized in its conventional location (circle); adrenal vein sampling assisted with intraoperative localization of the RAV (solid arrow) and inferior accessory hepatic vein (dotted arrow), avoiding misidentification of the RAV,
which could lead to blood loss. The RAV can be challenging to catheterize because of its short length and direct drainage into the inferior vena cava. Variant RAV anatomy can make sampling more difficult. Identification of variant anatomy is crucial to avoid nonselective sampling and may help with intraoperative localization.
b.
a.
From The University of New South Wales (S.N.), UNSW Medicine, Sydney, NSW 2052, Australia; and Department of Surgery (A.D.) and Division of Vascular and Interventional Radiology (M.L.L.), The Johns Hopkins Hospital, Baltimore, Maryland. E-mail: [email protected] M.L.L. was sponsored by Merit Medical. Neither of the other authors has identified a conflict of interest. & SIR, 2014. Published by Elsevier Inc. All rights reserved. J Vasc Interv Radiol 2014; 25:1775 http://dx.doi.org/10.1016/j.jvir.2014.07.026
c.
Variant Adrenal Vein Anatomy: Free with Sample Sindhura Nirmalarajan, BMed, Alan Dackiw, MD, PhD, and Mark L. Lessne, MD
A 54-year-old man with primary hyperaldosteronism presented for adrenal vein sampling. Computed tomography performed before the procedure (a) suggested variant right adrenal vein (RAV) anatomy (solid arrow) as a shared confluence with an inferior accessory hepatic vein (dotted arrow). Venography performed during selective adrenal vein sampling (b) demonstrated the confluent anatomy of the RAV (solid arrow) and inferior accessory hepatic vein (dotted arrow). RAV selectivity was subsequently confirmed by laboratory analysis. During laparoscopic adrenalectomy (c), the RAV was not visualized in its conventional location (circle); adrenal vein sampling assisted with intraoperative localization of the RAV (solid arrow) and inferior accessory hepatic vein (dotted arrow), avoiding misidentification of the RAV,
which could lead to blood loss. The RAV can be challenging to catheterize because of its short length and direct drainage into the inferior vena cava. Variant RAV anatomy can make sampling more difficult. Identification of variant anatomy is crucial to avoid nonselective sampling and may help with intraoperative localization.
b.
a.
From The University of New South Wales (S.N.), UNSW Medicine, Sydney, NSW 2052, Australia; and Department of Surgery (A.D.) and Division of Vascular and Interventional Radiology (M.L.L.), The Johns Hopkins Hospital, Baltimore, Maryland. E-mail: [email protected] M.L.L. was sponsored by Merit Medical. Neither of the other authors has identified a conflict of interest. & SIR, 2014. Published by Elsevier Inc. All rights reserved. J Vasc Interv Radiol 2014; 25:1775 http://dx.doi.org/10.1016/j.jvir.2014.07.026
c.
