Case Report: Anomalous drainage vein sampling for diagnosing aldosterone-producing lesions undetectable by segmental adrenal venous sampling in a two-case series.

Frontiers in radiology Pub Date : 2025-06-10 eCollection Date: 2025-01-01 DOI:10.3389/fradi.2025.1567779
Hiromitsu Tannai, Sota Oguro, Hiroki Kamada, Yuta Tezuka, Yoshikiyo Ono, Kei Omata, Kei Takase
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Abstract

Adrenal vein sampling (AVS) is the gold standard for subtyping primary aldosteronism (PA). However, through conventional AVS, unilateral PA may be misdiagnosed as bilateral PA. Compared with conventional AVS, segmental AVS with additional sampling in adrenal tributaries can detect aldosterone-producing adenomas (APAs) with higher sensitivity. Herein, we describe two cases wherein high aldosterone levels were not detected through initial segmental AVS but were identified in anomalous drainage veins during the second AVS session. In Case 1, computed tomography (CT) during left adrenal arteriovenography revealed a fine renal capsular vein connecting an adrenal nodule to the third lumbar vein. Sampling in this vein during the second AVS revealed high aldosterone levels. The surgical specimen showed the presence of an 11 mm APA. Furthermore, Case 2 presented with bilateral small adrenal nodules; bilateral renal capsular vein sampling was performed during the second AVS session. The samples from the renal capsular vein connected to the renal vein revealed considerably high aldosterone levels. Left adrenalectomy revealed the presence of a 6 mm aldosterone-producing nodule. These cases highlight the importance of anomalous drainage vein sampling, the limitation of conventional and segmental AVS in diagnosing PA, and the utility of CT during adrenal arteriovenography for estimating the drainage route.

病例报告:异常引流静脉取样诊断醛固酮产生的病变无法检测的节段性肾上腺静脉取样在两个病例系列。
肾上腺静脉取样(AVS)是原发性醛固酮增多症(PA)分型的金标准。然而,通过常规AVS,单侧PA可能被误诊为双侧PA。与传统的AVS相比,在肾上腺支管内额外取样的节段AVS检测醛固酮生成腺瘤(APAs)的灵敏度更高。在此,我们描述了两个病例,其中高醛固酮水平未通过初始节段AVS检测到,但在第二次AVS期间在异常引流静脉中被发现。病例1,左肾上腺动静脉造影时的计算机断层扫描(CT)显示一条细肾包膜静脉连接肾上腺结节和第三腰椎静脉。在第二次AVS期间,静脉采样显示高醛固酮水平。手术标本显示有11mm的APA。此外,病例2表现为双侧小肾上腺结节;在第二次AVS期间进行双侧肾包膜静脉采样。连接肾静脉的肾包膜静脉的样本显示相当高的醛固酮水平。左肾上腺切除术显示一个6mm的醛固酮产生结节。这些病例强调了异常引流静脉取样的重要性,常规和分段AVS诊断PA的局限性,以及肾上腺动静脉造影中CT对估计引流路径的应用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
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