Middle Adrenal Artery Research Articles

FRI240 Aspirin Induced Adrenal Hemorrhage: Rare Side Effect Of A Common Medication!

Abstract Disclosure: H.A. Qadeer: None. R. Samkutty: None. V. Singh: None. Introduction: Adrenal hemorrhage is a heterogeneous disorder with various clinical presentations. Bilateral adrenal hemorrhage can result in acute adrenal insufficiency that can be fatal. With the increasing use of DOAC, cases of anticoagulation therapy induced adrenal hemorrhage have been reported. We present a rare case of unilateral adrenal hemorrhage in a patient with pre-existing adrenal myelolipoma after using Aspirin. Based on our literature search, previously only two cases of Aspirin Induced adrenal hemorrhage in a stable adrenal mass have been reported. Case Presentation: 55-year-old male with history of stable 6.2 cm right adrenal gland myelolipoma, fatty liver disease and hypertension, recent use of 2 doses 81 mg Aspirin after receiving right shoulder replacement surgery presented to emergency department with acute onset right sided flank pain, constant, radiating to the back and right upper quadrant associated with an episode of vomiting. He was hemodynamically stable. Blood work showed normal electrolytes, liver function and renal function at baseline. Hemoglobin was stable around 10g/dL. CT scan abdomen/pelvis with contrast showed increase in the size of a previously stable adrenal myelolipoma to 12.9 x 15.6 cm with mass effect upon the liver. Acute hemorrhage was suspected with the blood extending beyond the margins of the mass into the right retroperitoneal space, displacing the right kidney. On admission, aspirin was discontinued. With absence of hemodynamic instability, normal electrolytes, and normal AM cortisol level of 11.9 mcg/dL, adrenal insufficiency was ruled out. Hormonal work up for hyperfunctioning adrenal tumor was performed that ruled out pheochromocytoma, Cushing syndrome and Primary Aldosteronism. With symptomatic improvement, absence of progression of adrenal hemorrhage on repeat CT scan of the abdomen/pelvis, patient was discharged home. He received IR guided embolization of the right superior adrenal artery and middle adrenal artery in the outpatient setting. Discussion: Spontaneous adrenal gland hemorrhage is a rare event. Bilateral adrenal hemorrhage is associated with acute adrenal insufficiency that can be fatal. Major risk factors for adrenal hemorrhage include anticoagulant therapy, heparin Induced thrombocytopenia, hypercoagulable state, trauma and sever sepsis. Here we have reported a rare case of adrenal gland hemorrhage with therapeutic dose of aspirin used after orthopedic surgery. Aspirin is a very commonly used medication and high index of suspicion is required to avoid this side effect as Immediate discontinuation of the medication is necessary to prevent progression of the disease. Conclusion: Aspirin use can be associated with progression of stable benign adrenal tumors by causing spontaneous hemorrhage. A high index of clinical suspicion is required for timely recognition of this side effect. Presentation: Friday, June 16, 2023

Evaluation of fetal adrenal artery Doppler velocimetry and fetal adrenal gland size in pregnancies after recovery from COVID-19.

Assessment of the fetal adrenal gland (FAG) size and middle adrenal artery (MAA) Doppler parameters in pregnancy recovered from Coronavirus Disease (COVID-19) and comparison of the values with the healthy control group. Thirty-eight pregnant women who had recovered from COVID-19 infection and 76 healthy control group between 33 and 35 weeks of gestation were involved in this case-control study. Fetuses were examined for fetal biometry, fetal well-being, adrenal gland dimensions, and Doppler parameters 4-6 weeks after the diagnosis of COVID 19 infection. FAG dimensions were measured in two planes and MAA blood flow velocity was evaluated with pulsed Doppler. Pregnant women with COVID-19 infection were grouped according to the National Institutes of Health for the severity of the disease, and those with mild and moderate infections were examined in the study. The total adrenal gland (TAG) height, fetal zone (FZ) length and width, and MAA-Peak Systolic Velocity (MAA-PSV) were significantly higher, and the MAA-Pulsatility Index (MAA-PI) was significantly lower in the COVID-19 group (p < 0.05). The lower in MAA-PI and the higher in MAA-PSV, the width of the FZ, and width of the TAG were found to be significant in the moderate group compared to the mild groups (p < 0.05). COVID-19 pregnancies might cause early maturation of the FAG and its vasculature depends on the intrauterine stress due to the hyper-inflammation, so fetuses exposed to maternal COVID-19 suggested to have an increase in blood flow to the adrenal gland and fetal adrenal size.

Sjúkratilfelli Skyndileg aftanskinublæðing

A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal hemorrhage with suspected tumor at the left adrenal gland. He was quickly stabilized with intravenous fluids and blood transfusion. Rebleed occurs roughly a week after discharge and a new CT showed a visceral pseudoaneurysm from the left middle adrenal artery. The pseudoaneurysm was embolized and the patient discharged in good condition. Follow-up MRI depicted reabsorption of the hematoma and no adrenal tumor. Thus, the etiology of the previous retroperitonal hemorrhage is considered spontaneous.

Balloon-occluded middle adrenal artery embolization and percutaneous microwave ablation of a metastatic adrenal tumor from renal cell carcinoma.

Renal cell carcinomas present with locally advanced or metastatic disease in 25% of patients. Thermal ablation may be considered in selected patients with single-site or oligometastatic disease in selected patients. We describe single-session transarterial particle embolization with the assistance of a balloon-occlusion catheter and microwave ablation of a large hypervascular adrenal metastasis using cone beam CT and fluoroscopic XperGuide needle guidance.

Evaluation of fetal middle adrenal artery Doppler and fetal adrenal gland size in pregnancies with fetal growth restriction: a case-control study.

This study aims to evaluate sonographic measurements of fetal adrenal gland size and middle adrenal artery Doppler in pregnancies with fetal growth restriction (FGR) and in a healthy control group. This prospective study included 107 singleton pregnancies with FGR between 24 and 42weeks of gestation and 107 pregnancies with fetuses whose growth was appropriate for gestational age (AGA). Adrenal gland size and Doppler parameters of the adrenal artery were measured and the values and obstetric outcomes were compared between the study and control groups. In the study group, the Z-scores of total adrenal width-length and height, fetal zone width-length and middle adrenal artery-peak systolic velocity (MAA-PSV) were significantly higher than those in the control group (p<0.05). The Z-scores of middle adrenal artery-pulsatility index (MAA-PI) were significantly lower in the study group than in the control group (p<0.05). The rate of neonatal intensive care unit admission in fetuses with high adrenal artery PI scores was higher in the FGR group (p<0.05). In the present study, we observed decreased adrenal artery PI, increased adrenal blood flow, and increased fetal adrenal volume in fetuses diagnosed with fetal growth restriction, most likely in response to placental insufficiency and chronic hypoxia.

Zone-specific reference ranges of fetal adrenal artery Doppler indices: a longitudinal study

BackgroundThe fetal adrenal gland is a highly vascularized organs and develops two recognizable distinct zones in uetro, inner fetal zone (FZ) and outer definitive zone (DZ). Based on the region supplied, middle adrenal artery (MAA) mainly contribute to FZ while inferior adrenal artery (IAA) mainly to the inferior part of DZ. The purpose of this study was to establish reference ranges of adrenal artery Doppler indices of IAA and MAA, and assess zonal difference of blood supply to fetal adrenal gland.MethodsThe pulsatility index (PI), resistance index (RI), and systolic:diastolic ratio (S/D) of the IAA and MAA were obtained serially at 4-week intervals in normal fetuses. The MAA and IAA were referred based on the course and location in the gland: IAA referring the artery that mainly branches from the renal artery and walks along the renal upper pole, distributing the inferoposterior part of DZ in the adrenal gland while MAA as arterial blood flowing along the single central adrenal vein in the medial part of the gland. Multilevel modeling was performed to establish the gestational age-associated reference ranges for IAA and MAA. Differences in Doppler indices between the IAA and MAA were assessed.ResultsOne hundred sixty-eight fetuses with 843 observations were included. The IAA had a higher detection rate than the MAA (100% vs 89.2%, p < 0.05). The resistance of IAA had a reduction around 35 weeks of gestation and that of MAA remained unchanged throughout the second half of pregnancy. Lower PI, RI and S/D were observed in the MAA than in the IAA (p < 0.05) from 752 paired measurements.ConclusionThere is a zonal difference in blood supply in favor of the fetal zone, which may correspond to its unique function. Reference ranges of Doppler parameters in adrenal artery maybe beneficial for further evaluation of fetal hemodynamics.

Adrenal glands hemorrhages: embolization in acute setting.

Acute adrenal hemorrhages are a rare event compared to other abdominal visceral injuries because of the anatomic localization of the adrenal glands; main causes are trauma and ruptured neoplasms. This manuscript reports on a single center experience of transarterial embolizations of adrenal hemorrhages in emergency setting. In this retrospective analysis from 2010 to date, 17 patients (12 men and 5 women, mean age: 59.8 years) presenting with adrenal bleedings were treated by endovascular embolization. The etiology was traumatic in 7 cases, ruptured neoplasm in 8 cases and spontaneous in 2 patients assuming oral anticoagulant therapy. After thin slice contrast enhanced CT, a superselective embolization was conducted with different embolizing agents according to the type of vessel lesion and operator preference. Technical success rate, considered as interruption of adrenal bleeding detectable at angiography, was 94.1%. Clinical success rate, considered as hemodynamic stability restoration within 24 hours from the procedure, was 82.3%. Vessels involved were the superior adrenal artery in 5 patients, the middle adrenal artery in 8 patients, the inferior adrenal artery in one patient and more than one adrenal artery in 3 patients. No procedure-related major complications occurred and no patients had infarctions, necrosis, abscess formation, or required long-term steroid supplementation. Acute adrenal hemorrhages can be safely and effectively managed by catheter directed embolizations; the source of bleeding has to be carefully investigated at CT and angiography because adrenal glands present with a wide and complex vascular arterial network.

Spontaneous rupture of adrenal incidentaloma in a patient with subclinical Cushing’s syndrome, whose clinical expression is metabolic syndrome

A 68-year-old female with enlarged bilateral adrenal glands who was being monitored for metabolic syndrome (MetS) and subclinical Cushing’s syndrome was admitted to our hospital because of rupture of the left adrenal gland. We performed abdominal aortography and embolization of the left middle adrenal artery, and the patient’s pain resolved soon afterwards. After the left adrenal rupture, endocrinological studies still showed subclinical Cushing’s syndrome, and she exhibited no changes in the metabolic disorders. Because she refused removal of the left adrenal gland, we observed her clinical course carefully. One year after the adrenal gland rupture, abdominal computed tomography revealed complete absorption of the retroperitoneal hemorrhage and 131I-adosterol scintigraphy showed a similar result to that previously found. Although adrenal rupture is a rare condition, we should be aware of its possibility during the follow-up of incidental adrenal tumors. Subclinical Cushing’s syndrome has many common features with lifestyle diseases, such as excessive visceral fat, hypertension, metabolic disorders of glucose and lipids. Careful examinations are needed to follow up many patients with lifestyle-related diseases or MetS for a long period.

Massive Retroperitoneal Adrenal Hemorrhage Secondary to Lung Cancer Metastasis Treated by Adrenal Artery Embolization

The development of adrenal hemorrhage from lung cancer metastasis is extremely rare. A 54-year-old woman with stage IV Non–Small-cell lung cancer and known bilateral adrenal metastasis developed severe right-sided abdominal pain while undergoing chemotherapy treatment. A computerized tomography scan of the abdomen with intravenous contrast demonstrated massive right-sided retroperitoneal hemorrhage. The bleeding vessel was identified as the right middle adrenal artery. The patient underwent successful transcatheter embolization (TCE) and occlusion of the right middle adrenal artery using metallic coils, with resolution of the abdominal pain and stabilization of her hemoglobin. TCE can be used to control hemorrhage arising from metastatic involvement of the adrenal gland.

Perinatal adaptive response of the adrenal and carotid blood flow in sheep fetuses subjected to total cord occlusion

Objective. To investigate the perinatal adaptive response of the adrenal blood flow/adrenal fractional moving blood volume (AFMBV) and carotid blood flow (CBF), in sheep fetuses subjected to severe acute intrauterine hypoxia/asphyxia induced by total cord occlusion.Methods. Adrenal blood flow velocity, AFMBV and CBF were measured in 13 exteriorized fetal sheep; eight of them underwent total umbilical cord occlusion to induce severe acute hypoxia/asphyxia. Five lambs were used as sham controls. Middle adrenal artery pulsatility index (MAAPI) and mean velocity (MAAMV) were recorded with pulsed Doppler ultrasound. AFMBV was estimated using power Doppler ultrasound. CBF was recorded with a transonic flowmeter. In the neonatal period, after resuscitation all lambs were followed for a 4-hour period and AFMBV and CBF were recorded. Mean arterial blood pressure (MABP) and fetal heart rate were recorded continuously. Arterial cortisol levels were measured at the beginning and at the end of the fetal and neonatal periods.Results. Following the total cord occlusion, there was a significant reduction in the CBF, MABP, and heart rate and adrenal flow/AFMBV after 2, 4 and 5?min, respectively. Cortisol levels in the asphyctic lambs at the end of the cord occlusion were significantly lower than those in controls. After resuscitation, the asphyctic lambs showed increased AFMBV and cortisol levels, and reduced MABP as compared to control lambs. No differences were found in CBF, MAAPI and MAAMV. Thereafter, no differences were observed between the two groups in any of the studied parameters. At the end of the cord occlusion period, there was a significant correlation between AFMBV and MABP (r?=?0.69), between AFMBV and CBF (r?=?0.65) and between CBF and MABP (r?=?0.89).Conclusion. During severe acute intrauterine hypoxia, the fetal lamb is able to maintain the blood flow to the brain and the adrenal gland for 3–5?min. Changes in the AFMBV and the CBF were highly correlated to the changes in MABP. Adrenal FMBV and cortisol levels were higher in lamb neonates exposed to severe intrauterine asphyxia.

Perinatal adaptive response of the adrenal and carotid blood flow in sheep fetuses subjected to total cord occlusion

To investigate the perinatal adaptive response of the adrenal blood flow/adrenal fractional moving blood volume (AFMBV) and carotid blood flow (CBF), in sheep fetuses subjected to severe acute intrauterine hypoxia/asphyxia induced by total cord occlusion. Adrenal blood flow velocity, AFMBV and CBF were measured in 13 exteriorized fetal sheep; eight of them underwent total umbilical cord occlusion to induce severe acute hypoxia/asphyxia. Five lambs were used as sham controls. Middle adrenal artery pulsatility index (MAAPI) and mean velocity (MAAMV) were recorded with pulsed Doppler ultrasound. AFMBV was estimated using power Doppler ultrasound. CBF was recorded with a transonic flowmeter. In the neonatal period, after resuscitation all lambs were followed for a 4-hour period and AFMBV and CBF were recorded. Mean arterial blood pressure (MABP) and fetal heart rate were recorded continuously. Arterial cortisol levels were measured at the beginning and at the end of the fetal and neonatal periods. Following the total cord occlusion, there was a significant reduction in the CBF, MABP, and heart rate and adrenal flow/AFMBV after 2, 4 and 5 min, respectively. Cortisol levels in the asphyctic lambs at the end of the cord occlusion were significantly lower than those in controls. After resuscitation, the asphyctic lambs showed increased AFMBV and cortisol levels, and reduced MABP as compared to control lambs. No differences were found in CBF, MAAPI and MAAMV. Thereafter, no differences were observed between the two groups in any of the studied parameters. At the end of the cord occlusion period, there was a significant correlation between AFMBV and MABP (r=0.69), between AFMBV and CBF (r =0.65) and between CBF and MABP (r=0.89). During severe acute intrauterine hypoxia, the fetal lamb is able to maintain the blood flow to the brain and the adrenal gland for 3-5 min. Changes in the AFMBV and the CBF were highly correlated to the changes in MABP. Adrenal FMBV and cortisol levels were higher in lamb neonates exposed to severe intrauterine asphyxia.

Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Fed by the Reconstructed Inferior Phrenic Artery: Anatomical and Technical Analysis

To evaluate reconstructed patterns of occluded inferior phrenic artery (IPA) and determine the technical success rate and complications of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) fed by the occluded IPA through the anastomosing branch. In 19 patients, 24 IPAs, including two that had been previously embolized, were demonstrated through collateral pathways. The incidence of each collateral circulation was evaluated. Thirteen IPAs in 12 patients fed the tumor and TACE was attempted. TACE was performed only if the catheter could be advanced into the anastomosing branch so that the nontarget branches were avoided. A reconstructed unilateral IPA was observed in 14 patients (11 right IPAs and three left IPAs) and two reconstructed IPAs were observed in five. The IPA was demonstrated through the dorsal pancreatic artery (n = 13), inferior or middle adrenal artery (n = 7), left gastric artery (n = 2), contralateral IPA (n = 2), lumbar artery (n = 1), and small branch derived from the celiac trunk (n = 1). Five IPAs (21%) were demonstrated through more than two separate arteries, including two demonstrated through both dorsal pancreatic arteries arising from the celiac and superior mesenteric artery. The IPA opacified through the lumbar artery had been previously embolized. TACE of the reconstructed IPA was possible in 10 of 13 IPAs (77%). Complications related to the procedure were a small amount of pleural effusion (n = 4) and basal atelectasis (n = 2). The IPA is reconstructed mainly through the retroperitoneal anastomosing branch in the upper abdomen. TACE of the reconstructed IPA can be performed with a high success rate without major complications.

Spontaneous Ruptured Adrenal Artery Aneurysm

Visceral artery aneurysm is an uncommon condition that can require emergency treatment. We describe a rare aneurysm in the left middle adrenal artery that spontaneously ruptured, leading to retroperitoneal hemorrhage. CASE REPORT A 68-year-old Japanese man with a history of coronary artery bypass grafting for angina pectoris, and a 1-year history of hypertension and renal insufficiency presented with left flank pain that had manifested suddenly while the patient was taking a hot bath. At presentation blood pressure was 118/70 mm. Hg and the patient was conscious. On examination the left abdominal wall was swollen and left lumbar pain was causing the patient severe distress. Laboratory tests showed severe anemia (hematocrit 18.3%, normal 38.2% to 50.8%). Computerized tomography revealed a large left retroperitoneal hematoma (fig. 1, A). Emergency aortography demonstrated an irregular aortic wall and an aneurysm of the left middle adrenal artery (fig. 1, B). Selective angiography showed that the aneurysm had ruptured and was bleeding into the retroperitoneal space (fig. 2, A). Transcatheter embolization was performed using 6 fibered 0.018-inch platinum microcoils (Tornado, Cook, Inc., Bloomington, Indiana) and a coaxial catheter system (Progreat, Terumo Corp., Tokyo, Japan). The distal tip of the catheter was positioned in the feeding artery just proximal to the aneurysm (fig. 2, B). The 6 fibered microcoils were positioned to obstruct completely the middle adrenal artery and the aneurysm. Temporary hemodialysis was necessary, because renal failure ensued. Symptoms subsequently resolved completely, and the patient was doing well at 11-month followup. DISCUSSION

Doppler velocimetry in the adrenal artery in human fetuses.

Fetal hypoxia and/or acidosis causes redistribution of blood flow to the high-priority organs including the adrenal glands. Although this phenomenon is well described in the human cerebral and placental circulations using Doppler velocimetry, there are few reports about the adrenal glands. To clarify the gestational age-related changes in adrenal blood flow in normal fetuses and fetuses at risk of hemodynamic derangement. In 153 normal cases, the resistance indices (RIs) calculated from the blood flow velocity waveforms (FVWs) in the middle adrenal artery (MAA) were obtained from 24 weeks to construct nomogram using regression analysis. Twenty-seven complicated cases were divided according to the 5%ile RI values in the MAA, and clinical outcomes were retrospectively compared. The RI values in the MAA increased until 31 weeks and decreased thereafter. The 50%ile regression curve was represented as RI=-0.000914 (weeks)(2)+0.0579 weeks-0.181. Of the 27 complicated cases, 13 had RIs in the MAA below the 5%ile. Cases with low RI had significantly higher RI ratio in regard of UA/MCA; higher occurrence of abnormal FHR patterns on observation; higher incidence of cesarean delivery for nonreassuring fetal well-being status; earlier gestational age at delivery; lower birth weights and longer periods of admission to NICU than the cases with normal RI. We have described the nomogram for the RI in the MAA. In conditions of fetal hypoxia or acidemia, blood flow redistribution to the adrenal glands may occur and the analysis of the adrenal artery FVWs may be useful in detection of fetal altered hemodynamics.

WS15‐04The value of evaluation of adrenal circulation in predicting hypoxia of the fetus

From animal studies it is known that fetus during hypoxia redistributes it's blood flow preferentially to the brain, heart and adrenal glands. In animal studies, a three‐fold increase in adrenal blood flow has been demonstrated during hypoxia. The adrenals are relatively large organs in the fetus. Compared to fetal body weight, they are 20 times bigger than in the adult. The fetal adrenals respond to stress, such as hypoxemia by increased production of dihydroandrostendion (DHA), DHA sulfate and their metabolites. The adrenal gland is supplied by three arteries: the superior, coming from the inferior phrenic artery; the middle, from the abdominal aorta and inferior, arising from the renal artery. In the recent studies the Doppler signals were obtained from fetal middle adrenal artery. The normal adrenal PI shows decreasing values with the gestational age, which might suggest lower vascular resistance and high blood flow to the adrenals. From our observations the adrenal Doppler velocimetry is easier to record in fetuses from high‐risk pregnancies than in normals, probably due to the adrenal sparing effect. Recent results suggest that the adrenal artery velocimetry might be useful in fetal assessment and predicting outcome. The ‘adrenal‐sparing’ effect might be maintained at the same time the brain‐sparing signs disappear.

Second and third trimester Doppler F46Fetal cerebral and adrenal blood velocimetry in predicting hypoxia of the fetus

BackgroundAnimal studies have shown that hypoxic fetuses redistribute their blood flow, giving preferential supply to the brain, heart and adrenal glands. The aim of this study was to evaluate blood velocity waveforms in the fetal middle adrenal artery and cerebral arteries in relation to the outcome of high‐risk pregnancy.MethodsMiddle adrenal artery and anterior, middle and posterior cerebral arteries were recorded in 102 pregnancies complicated by pregnancy induced hypertension between 27 and 41 weeks of gestation. Signs of the fetal ‘adrenal‐sparing’ were considered present when pulsatility index (PI) was below the 95% confidence interval. Signs of fetal brain‐sparing were considered present when the cerebral arterial PI were &lt; mean −2 SD of the normals and cerebroplacental PI ratio &lt; 1.08. The blood velocimetry results were related to perinatal outcome.ResultsAdrenal velocimetry was strongly associated with aDVerse perinatal outcome, being significant for all studied parameters. All perinatal mortality showed signs of adrenal sparing. Adrenal sparing, but not brain sparing, was correlated with fetal acidosis. Combining adrenal velocimetry with brain velocimetry shown worser predictive results than adrenal velocimetry itself.ConclusionFetal adrenal sparing is more predictive of perinatal outcome in high‐risk pregnancies and might be maintained longer than the brain‐sparing sign.

Laparoscopic direct supragastric left adrenalectomy

Background: In this paper a novel laparoscopic approach to the left adrenal gland by the trans-abdominal anterior route is presented. This approach avoids an extensive viscera dissection to gain access to the left adrenal gland. Methods: The first step of the procedure is the division of the gastrophrenic ligament and the section of 1 or 2 short gastric vessels in order to mobilize the gastric fundus. The gastric fundus is then pulled down, allowing a wide exposure of the left crus of the diaphragm, the perirenal fat, and the superior edge of the pancreatic body. The diaphragmatic-adrenal channel runs on the left crus, crosses the middle adrenal artery, and, usually, joins the left adrenal vein before its junction with the left renal vein. By pulling on the diaphragmatic vein, exposure of the adrenal vein is facilitated. The adrenal vein is then isolated and divided between clips. Using the monopolar electrocautery to control arteries and small veins, the mobilization of the gland is then completed. The adrenal gland is then placed in a plastic bag to prevent cell spillage and removed through an enlarged umbilical incision. Results: During a 20-month period, 6 consecutive patients with left adrenal gland neoplasms have been operated on with the above mentioned original approach. The diameter of the adrenal mass ranged from 3 cm to 6 cm. No conversion to open surgery or complications have been registered. The mean operative time was 126 minutes. The mean length of hospitalization was 4.1 days (range 3 to 6). Conclusions: This approach offers a complete visualization of the left adrenal gland, avoiding mobilization of the spleen, pancreatic tail, and left flexure of the colon, and allows an early and easy control of the left adrenal vein so adrenalectomy can be safely performed.

Typology of abdominal arteries, with special reference to inferior phrenic arteries and their esophageal branches.

Origins and distribution of the human inferior phrenic arteries were studied by dissecting 68 Japanese adult cadavers. The inferior phrenic arteries were usually observed as paired (left and right) vessels. Their origins were summarized as follows: a) the aorta itself (85/138 cases, 61.6%), b) the ventro-visceral arteries (celiaco-mesenteric system of the aorta) including the celiac trunk (39/138 cases, 28.2%) and the left gastric artery (4/138 cases, 2.9%), and c) the latero-visceral arteries (adreno-renal system of the aorta) including the middle adrenal artery (4/138 cases, 2.9%) and the renal artery (6/138 cases, 4.3%). The left and right arteries occasionally originated in common trunk from the aorta, celiaco-mesenteric system or adreno-renal system (22/138 cases, 15.9%). A typological diagram explaining these variations is given. The inferior phrenic arteries, especially the left ones, sometimes issued visceral or esophageal branches. This fact indicates that the inferior phrenic arteries are homologous with the celiac trunk and mesenteric arteries. It is further discussed that the celiac trunk and mesenteric arteries are originally paired vessels, through introduction of our previous typological diagram of the abdominal arteries.