Adrenal venography.

Abstract

Evaluation of adrenal gland abnormalities remains one of the difficult areas in roentgen diagnosis. An adrenal lesion must be large to be detected on plain abdominal films. Retroperitoneal air study reveals only the shape and size of the gland and is subject to misinterpretation. Arteriography can demonstrate the presence of some adrenal tumors, particularly vascular tumors such as pheochromocytomas (2), but adrenal adenomas and adrenal hyperplasia do not have an abundance of newly formed vessels and therefore are usually poorly demonstrated by arteriography. Moreover, the multiple origin of adrenal arteries from the inferior phrenic artery, the aorta, and the renal arteries (12) makes selective arteriography of the adrenal gland impossible. Kahn (8) has performed selective catheterization of the inferior phrenic arteries but states that it is technically difficult. Winkler and he (15) have also obtained better filling of adrenal arteries at celiac and renal angiography by injecting contrast medium following the administration of adrenalin. A new approach to adrenal diagnosis was suggested in 1962 by Starer (14) and also by Bucht (3). These investigators demonstrated adrenal adenomas by a retrograde injection of contrast medium into the left adrenal vein. Both, however, concluded that the method had little future because of the difficulty they encountered in catheterizing the right adrenal vein. Masoni (10) has described a method for catheterizing the right adrenal vein but did not perform venography of the gland. Because of the shortcomings of the other roentgen approaches to adrenal diagnosis, a further appraisal of adrenal venography seems justified. Our experience with the technic in 45 patients forms the basis of this report. Anatomy When compared with the multiple and varied origin of adrenal arteries, the venous drainage of the gland is singular and regular (1). This is particularly true of the left gland, from which the intra-adrenal and adrenal capsular veins collect into a single vein, which exits at the lower pole of the gland. Just below the gland, the left adrenal vein usually receives the left inferior phrenic vein and a renal capsular vein. The confluence of the three then enters the superior surface of the mid-left renal vein. On the right the venous drainage of the gland is less constant, but a complete anatomic study of the relative frequency of occurrence of the variations is not available. It is generally stated that in the majority of persons a single vein drains the right gland and directly enters the right posterolateral aspect of the inferior vena cava 2 to 4 cm above the right renal vein (1). In some persons a single right adrenal vein has a common origin with or drains into an hepatic vein. Occasionally, two or three right adrenal veins may be present, draining into the inferior vena cava, hepatic veins, or rarely into the right renal vein (6, 7).