CASE REPORT article
Front. Radiol.
Sec. Interventional Radiology
Volume 5 - 2025 | doi: 10.3389/fradi.2025.1567779
This article is part of the Research TopicAdvances in Venous InterventionsView all articles
Anomalous Drainage Vein Sampling for Diagnosing Segmental Adrenal Venous Sampling-Undetectable Aldosterone-Producing Lesions: A Two-Case Series
Provisionally accepted
- 1Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
- 2Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Sendai, Japan
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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 a 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.
Keywords: Adrenal venous sampling, Aldosterone-producing adenoma, primary aldosteronism, Hypertension, computed tomography
Received: 28 Jan 2025; Accepted: 22 May 2025.
Copyright: © 2025 Tannai, Oguro, Kamada, Tezuka, Ono, Omata and Takase. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hiromisu Tannai, Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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