Super-Selective Adrenal Venous Sampling: A Diagnostic Tool when Planned, but a Liability when Incidental

Authors

  • Mohammad Abou El-Ezz University of Louisville School of Medicine, Louisville
  • Tarek Daoud University of Louisville School of Medicine, Louisville/ Department of Radiology, University of Louisville Hospitals, Louisville
  • Rocklin Schumaker University of Louisville School of Medicine, Louisville/ Department of Radiology, University of Louisville Hospitals, Louisville
  • Yaw Ohene-Baah University of Louisville School of Medicine, Louisville/ Department of Radiology, University of Louisville Hospitals, Louisville

DOI:

https://doi.org/10.3941/jrcr.5913

Abstract

Adrenal vein sampling (AVS) is considered the gold standard for differentiating unilateral from bilateral primary hyperaldosteronism. However, anatomical variations in adrenal venous drainage can complicate interpretation. We report the case of a 55-year-old female referred for evaluation of primary hyperaldosteronism and resistant hypertension who underwent technically successful AVS, yet with inconclusive results, warranting a repeat AVS. During the repeat procedure, an unusual venous variant was identified: a right superior and inferior adrenal vein. Recognition of this variant was essential to avoid misinterpretation of results. This case highlights the importance of understanding venous anatomy during AVS and the need for meticulous venographic evaluation when unexpected findings are encountered.

adrenal vein inferior tributary identified on initial AVS. Notably, the vein courses medially from the IVC.

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Published

2026-04-27

Issue

2026: Articles in Press

Section

Interventional Radiology

License

Copyright (c) 2026 Journal of Radiology Case Reports

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