Hirohumi Hokotate

Left renal vein aneurysm: imaging findings

AbstractA renal vein aneurysm is a rare vascular disease. To our knowledge, only six cases have been reported. We describe a 57-year-old woman with a left renal vein aneurysm diagnosed by a combination of ultrasonography, color Doppler ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging.

Transcatheter Adrenal Arterial Embolization of Cortisol-Producing Tumors

Transcatheter arterial embolization (TAE) was performed in 2 patients with Cushings syndrome caused by adrenal adenoma by using a mixture of absolute ethanol and iohexol. In 1 patient successful suppression of the hypersecretion of cortisol has continued for 9 months after TAE without complications. However, in the other patient, TAE was discontinued due to marked hypertension and tachycardia induced by a massive release of catecholamines from the embolized “normal” part of the tumor-bearing adrenal gland during the procedure. These results suggest that it is important to perform TAE of only the arterial branches feeding the tumor.

Non-surgical therapy of primary aldosteronism: transcatheter arterial infusion of ethanol into an aldosteronoma.

Primary aldosteronism due to an adrenocortical adenoma can be cured by ablation of the adenoma, which produces an excess of aldosterone (aldosteronoma). This has traditionally been performed by surgical removal of the adenoma. However, some patients with aldosteronomas refuse surgical removal. Therefore, we developed a therapeutic method to ablate an aldosteronoma by transcatheter arterial infusion of ethanol. This method ablated the aldosteronoma in 27 (82%) of 33 treated cases and produced no serious complications, and may be one of the therapeutic choices for aldosteronomas.

Comparison of adrenal vein sampling value between aldosterone producing adrenal adenoma and non-functioning adrenal adenoma : Evaluation using receiver operating characteristic analysis

Purpose: To evaluate adequate criteria for adrenal vein sampling values in patients with aldosterone producing adrenal adenoma (APA), retrospectively. Material and Methods: Between 1988 and 2002, 59 hypertensive patients (15 M and 44 F, aged 47.58±9.45 years) were referred to our hospital and diagnosed with APA based on established criteria. During the same period, 23 patients with non-functioning adrenal adenoma (11 M and 12 F aged 53.56±11.76 years) were diagnosed based on computed tomography and laboratory data. Results: All 82 patients were enrolled in the present study. Bilateral adrenal vein sampling (AVS) for measurement of plasma aldosterone (A) and cortisol (C) was performed, and a receiver operating characteristics (ROC) analysis was conducted to establish the best criteria from the AVS-derived index in patients with APA. A (APA side)/A (contralateral side) was confirmed to provide the best diagnostic accuracy {(>2.5: right APA, sensitivity 83.3%, specificity 79.5%), (>3: left APA, sensitivity 84.2%, specificity 76.9)}. The Az values for A (APA side)/A (contralateral side) were 0.8948 and 0.9260 for right and left APA, respectively. Conclusion: The A (APA side)/A (contralateral side) value was the best compromise for sensitivity and false-positive rate for lateralization of APA.

Visualization of the Internal Mammary Artery via the Hepatic Falciform Artery in a Patient with Hepatocellular Carcinoma

The hepatic falciform artery is a small vessel that arises as a terminal branch of the middle or left hepatic artery. Its anatomy and clinical importance have been described in several recent reports. During dissection of a cadaver, this artery is generally found connected with the ensiform branch of the internal mammary artery. However, to our knowledge, anastomosis has not previously been described radiologically.