CASE 11220 Published on 18.10.2013

Importance of The Inferior Phrenic Artery Origin in Renal Transplantation

Section

Uroradiology & genital male imaging

Case Type

Anatomy and Functional Imaging

Authors

Mecit Kantarci, Hayri Ogul, Ummugulsum Bayraktutan, Leyla Karaca, Berhan Pirimoglu, Yesim Kizrak

Erzurum, Turkey; Email:akkanrad@hotmail.com
Ataturk University, School of Medicine, Department of Radiology, Erzurum, Turkey
Patient

29 years, male

Categories
Area of Interest Abdomen ; Imaging Technique CT-Angiography, Image manipulation / Reconstruction
Clinical History
A 29 year old male was referred to our radiology department for multidedector computed tomography (MDCT) angiography as a pre-operative investigation for potential live kidney donor.
Imaging Findings
Scanning was performed with a 256-slice MDCT (High Definition, Siemens, Erlangen Germany) unit. Scanning protocol consists of an initial unenhanced study to identify the liver location with 5 mm collimation. Subsequently, intravenous contrast injection of 110–140 ml of non-ionic iodinated contrast material containing 350 mg of iodine per milliliter was performed through 18 G cannula placed into the right median cubital vein at a rate of 4 ml/s using power injector. Arterial-phase imaging was initiated within 5 s after enhancement of the descending aorta which has a attenuation of 100 HU, as measured by a bolus-tracking technique with 1.25 mm collimation. This was followed by portal (60 s delay) phase imaging with 5 mm collimation. The arterial-phase images were reconstructed at 1.25 mm thickness and 0.5 mm intervals. Views of orientations were reconstructed by Multi Planar Reformation (MPR) technique. We found origin of inferior phrenic artery from right renal artery.
Discussion
This article documents several important features of vascular anatomy and angiography and its importance in renal transplantation. The case we have presented regarding potential kidney donor has vascular variant of inferior phrenic artery origin from right renal artery. Inferior phrenic artery small paired vessel , in normal cadaver dissection showed the right inferior phrenic artery originate from celiac trunk in 40% of the specimen, aorta 45%, renal 17%, left gastric 3%, hepatic artery proper 2% of the specimen. As the inferior phrenic artery transverse upwards they give rise to eight notable branches: Ascending, descending, inferior vena cava, superior suprarenal, middle suprarenal, esophageal, diaphragmatic, hiatal and accessory splenic branch. While removing kidney from live donor, the blood vessel connected to kidney are dissected and clamped before the origin of inferior phrenic artery [1,2]. If renal artery of donor is dissected and clamped after the origin of inferior phrenic artery there are chances of necrosis of diaphragm and liver capsule. It can also cause hemoperitoneum, hemoptysis, gastro esophageal, diaphragmatic or hepatic bleeding. Branches of inferior phrenic artery such as superior suprarenal and middle suprarenal arteries are main vascular supply of adrenal gland so dissecting of this arteries may lead to necrosis of adrenal gland. If inferior phrenic artery arise from the middle of renal artery, the patient is not suitable for donating his kidney. Normal renal artery is 4 to 5 cm in length. İt is vital to spare as much as free vessel graft to achieve a healthy arterial anastomosis [3].
Differential Diagnosis List
The origin of inferior phrenic artery from right renal artery
The origin of inferior phrenic artery from celiac artery
The origin of inferior phrenic artery from aorta
Final Diagnosis
The origin of inferior phrenic artery from right renal artery
Case information
URL: https://www.eurorad.org/case/11220
DOI: 10.1594/EURORAD/CASE.11220
ISSN: 1563-4086