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Radiologic Anatomy of the Right Adrenal Vein: Preliminary Experience with MDCT

¹ Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, Miyagi, 980-8574, Japan.
² Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Position of right adrenal vein orifice, its relationship to surrounding structures, and direction of right adrenal vein. Transverse plane seen inferiorly shows position of right adrenal vein orifice, which was estimated along circumference of inferior vena cava (IVC) as an angle——between radius through orifice and x-axis in xy plane. Intersection of x- and y-axes is specified as center of IVC. Angle was measured positively in clockwise direction from x-axis, with a negative angle being in counterclockwise direction. When falls between 0° and 90°, right adrenal vein is described as entering IVC in right posterior quadrant; when falls between –90° and 0°, right adrenal vein is described as entering in left posterior quadrant.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Position of right adrenal vein orifice, its relationship to surrounding structures, and direction of right adrenal vein. Transverse plane observed inferiorly shows direction of right adrenal vein from IVC, which was measured in xy plane as angle 1 between projected figure of right adrenal vein and x-axis. Intersection of x- and y-axes is specified as junction between right adrenal vein and IVC. Angle 1 was measured positively in clockwise direction from x-axis, with negative angle being in counterclockwise direction.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Position of right adrenal vein orifice, its relationship to surrounding structures, and direction of right adrenal vein. Vertical plane paralleling right adrenal vein shows craniocaudal direction of right adrenal vein from IVC, which was measured as angle 2 between right adrenal vein and z-axis. Intersection of xy plane and z-axis is specified as junction between right adrenal vein and IVC. Angle 2 was measured from z-axis to right adrenal vein.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Examples of right adrenal vein show variable degrees of visualization. 54-year-old man with aortic dissection and right adrenal mass. Paraaxial multiplanar reformatted image shows excellent visualization of right adrenal vein (arrow) running through intervening adipose tissue to join right posterior quadrant of inferior vena cava (IVC). Length of right adrenal vein is 2.9 mm.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Examples of right adrenal vein show variable degrees of visualization. 87-year-old woman with thoracic and abdominal aortic aneurysm. Paraaxial multiplanar reformatted image shows right adrenal vein (arrow) and right adrenal gland located close to IVC. Although right adrenal vein is a small structure, measuring only 2.9 mm in length, good visualization of it is attained because of dense enhancement.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Examples of right adrenal vein show variable degrees of visualization. 54-year-old man with aortic dissection. Paraaxial multiplanar reformatted image shows right adrenal gland close to IVC. Linear structure connecting adrenal gland with IVC displays only slightly denser enhancement than right adrenal gland and is regarded as right adrenal vein (arrow). Visualization is graded fair. Length of right adrenal vein is 3.5 mm.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —56-year-old man with aortic dissection. Paraaxial multiplanar reformatted image shows right adrenal vein (arrow) that drains to accessory hepatic vein (arrowhead) before entering inferior vena cava. Lengths of right adrenal vein and common trunk were 3.0 and 4.1 mm, respectively.

View larger version (24K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Location of right adrenal vein orifice and direction of right adrenal vein from inferior vena cava (IVC). Data are numbers (%) of right adrenal veins. Craniocaudal level of orifice of right adrenal vein in relation to vertebral bodies and disks.

View larger version (26K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Location of right adrenal vein orifice and direction of right adrenal vein from inferior vena cava (IVC). Data are numbers (%) of right adrenal veins. Position of orifice of right adrenal vein along circumference of IVC evaluated as angle (dark gray).

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Location of right adrenal vein orifice and direction of right adrenal vein from inferior vena cava (IVC). Data are numbers (%) of right adrenal veins. Direction of right adrenal vein from IVC in transverse plane, which is represented as angle with x-axis (angle 1) (dark gray).

View larger version (22K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Location of right adrenal vein orifice and direction of right adrenal vein from inferior vena cava (IVC). Data are numbers (%) of right adrenal veins. Direction of right adrenal vein from IVC in vertical plane, which is represented as craniocaudal angle with z-axis (angle 2) (dark gray).

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —53-year-old woman with primary aldosteronism (patient not included in this study). Axial image shows that right adrenal vein (arrow) directly enters inferior vena cava (IVC), almost sharing common orifice with accessory hepatic vein (arrowhead). Medial limb of right adrenal gland (asterisk) is also seen. Length of right adrenal vein is 6 mm. Dotted line indicates extent of medial limb of right adrenal gland.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —53-year-old woman with primary aldosteronism (patient not included in this study). Axial image inferior to A shows adrenal mass of 16 mm (curved arrow).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —53-year-old woman with primary aldosteronism (patient not included in this study). Volume-rendered image shows adrenal gland mass (curved arrow, pink) and right adrenal vein (straight arrows, blue) that shares common orifice with accessory hepatic vein (arrowhead, green) and enters IVC at level of middle third of T12. IVC is shown in aqua.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —53-year-old woman with primary aldosteronism (patient not included in this study). Right adrenal venogram shows adrenal mass (curved arrow) with marginal stain, from which right adrenal vein (straight arrows) drains upward to join IVC, almost sharing a common orifice with accessory hepatic vein (arrowhead). Note similarity of relationship among adrenal mass, right adrenal vein, and accessory hepatic vein to that on volume-rendered image C.

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