DOI: 10.1148/rg.242035104
Multi–Detector Row CT Evaluation of Living Renal Donors Prior to Laparoscopic Nephrectomy1
Satomi Kawamoto, MD,
Robert A. Montgomery, MD, PhD,
Leo P. Lawler, MD,
Karen M. Horton, MD and
Elliot K. Fishman, MD
1 From the Russell H. Morgan Department of Radiology and Radiological Science (S.K., L.P.L., K.M.H., E.K.F.) and Department of Surgery (R.A.M.), Johns Hopkins Hospital, 601 N Caroline St, Room 3254, Baltimore, MD 21287-0801. Presented as an education exhibit at the 2002 RSNA scientific assembly. Received April 11, 2003; revision requested May 14 and received June 27; accepted June 27. All authors have no financial relationships to disclose. Address correspondence to E.K.F. (e-mail: efishman@jhmi.edu).
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Figure 1a. (a) Coronal volume-rendered image at the level of the abdominal aorta shows a normal left renal main artery (black arrows) and vein (white arrows) that have classic anatomic structure. (b) Coronal volume-rendered image slightly posterior to a shows an accessory artery (black arrow) and accessory vein (white arrows) connected to the lower pole of the left kidney and a small renal calculus in the upper pole (arrowhead). (c) Axial MIP image shows small bilateral renal calculi (arrowheads), as well as the classically structured main renal artery (black arrow) and vein (white arrow). (d) Axial volume-rendered image shows the polar artery (solid arrow) and the retroaortic polar vein (open arrows).
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Figure 1b. (a) Coronal volume-rendered image at the level of the abdominal aorta shows a normal left renal main artery (black arrows) and vein (white arrows) that have classic anatomic structure. (b) Coronal volume-rendered image slightly posterior to a shows an accessory artery (black arrow) and accessory vein (white arrows) connected to the lower pole of the left kidney and a small renal calculus in the upper pole (arrowhead). (c) Axial MIP image shows small bilateral renal calculi (arrowheads), as well as the classically structured main renal artery (black arrow) and vein (white arrow). (d) Axial volume-rendered image shows the polar artery (solid arrow) and the retroaortic polar vein (open arrows).
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Figure 1c. (a) Coronal volume-rendered image at the level of the abdominal aorta shows a normal left renal main artery (black arrows) and vein (white arrows) that have classic anatomic structure. (b) Coronal volume-rendered image slightly posterior to a shows an accessory artery (black arrow) and accessory vein (white arrows) connected to the lower pole of the left kidney and a small renal calculus in the upper pole (arrowhead). (c) Axial MIP image shows small bilateral renal calculi (arrowheads), as well as the classically structured main renal artery (black arrow) and vein (white arrow). (d) Axial volume-rendered image shows the polar artery (solid arrow) and the retroaortic polar vein (open arrows).
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Figure 1d. (a) Coronal volume-rendered image at the level of the abdominal aorta shows a normal left renal main artery (black arrows) and vein (white arrows) that have classic anatomic structure. (b) Coronal volume-rendered image slightly posterior to a shows an accessory artery (black arrow) and accessory vein (white arrows) connected to the lower pole of the left kidney and a small renal calculus in the upper pole (arrowhead). (c) Axial MIP image shows small bilateral renal calculi (arrowheads), as well as the classically structured main renal artery (black arrow) and vein (white arrow). (d) Axial volume-rendered image shows the polar artery (solid arrow) and the retroaortic polar vein (open arrows).
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Figure 2a. (a) Coronal volume-rendered image shows two left renal arteries (white arrows) and a single right renal artery, as well as a retroaortic left renal vein (black arrow). (b) Oblique coronal volume-rendered image shows the left renal vein behind the aorta (arrow).
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Figure 2b. (a) Coronal volume-rendered image shows two left renal arteries (white arrows) and a single right renal artery, as well as a retroaortic left renal vein (black arrow). (b) Oblique coronal volume-rendered image shows the left renal vein behind the aorta (arrow).
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Figure 3. Coronal volume-rendered image shows three left renal arteries that arise close together from the abdominal aorta (arrows).
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Figure 4. Coronal MIP image shows three left renal arteries that arise from the aorta at different levels (arrows).
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Figure 5. Coronal MIP image shows accessory renal arteries that arise from the aorta near the bifurcation (white arrows) and that supply the lower pole of each kidney, as well as early branching of two left renal arteries (black arrows).
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Figure 6. Oblique coronal volume-rendered image shows a circumaortic left renal vein (white arrow) and early branching of the left renal artery approximately 1.5 cm from its origin (black arrow).
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Figure 7a. Coronal (a) and axial (b) volume-rendered images show a retroaortic renal vein that drains into the inferior vena cava (arrow), as well as two right renal arteries.
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Figure 7b. Coronal (a) and axial (b) volume-rendered images show a retroaortic renal vein that drains into the inferior vena cava (arrow), as well as two right renal arteries.
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Figure 8. Coronal volume-rendered image shows a retroaortic renal vein that runs caudad and enters the inferior vena cava near the level of the aortic bifurcation (arrow).
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Figure 9. Coronal volume-rendered image shows typical locations of the left adrenal vein and left gonadal vein: The left adrenal vein (black arrow) enters the left renal vein from above and lateral to the abdominal aorta. The left gonadal vein (white arrow) enters the left renal vein from below and lateral to the left adrenal vein.
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Figure 10. Coronal volume-rendered image shows an atypically located left adrenal vein (arrow) that drains medially to the superior portion of the left renal vein where it overlaps the aorta.
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Figure 11a. Coronal (a) and sagittal (b) volume-rendered images show a prominent left lumbar vein that drains into the left renal vein (arrow).
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Figure 11b. Coronal (a) and sagittal (b) volume-rendered images show a prominent left lumbar vein that drains into the left renal vein (arrow).
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Figure 12. Volume-rendered image shows mild stenosis (arrow) of the right main renal artery just past its origin, with minimal poststenotic dilatation. Note the accessory renal artery that arises near the main artery and feeds the upper pole of the right kidney.
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Figure 13. Axial MIP image shows two nodular hypervascular lesions (arrow) in the right kidney that exhibit a level of contrast enhancement similar to that of the renal vasculature, a finding compatible with renal artery aneurysm or small arteriovenous malformation.
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Figure 14. Coronal MIP image shows enlarged pelvic varices that drain into an enlarged left gonadal vein (arrow).
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Figure 15. Coronal MIP image shows unusual accessory arteries that arise from the superior mesenteric artery and aorta and extend in a serpentine pattern along both sides of the aorta (arrows). At surgery, the corkscrew-like arteries were seen to course through the mesocolon and along the gonadal vein. Although great caution was used during surgery, these arteries were extremely fragile and avulsed from the aorta during elevation. Although good hemostasis was achieved by the end of the procedure, the subject developed intraperitoneal hemorrhage a few hours after nephrectomy and underwent emergent exploratory laparotomy to achieve hemostasis.
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Figure 16. Coronal volume-rendered image shows a horseshoe kidney supplied by multiple renal arteries.
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Figure 17. Topogram from delayed CT shows medullary blush (arrows), a finding compatible with sponge kidney. The diagnosis was confirmed with intravenous pyelography. Medullary blush is more evident in the right kidney than in the left kidney because there is no superimposed bowel air.
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Figure 18. Coronal volume-rendered image shows a 3-cm-diameter hypervascular mass (arrow) in the upper pole of the left kidney. The diagnosis was renal cell carcinoma.
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Figure 19. Oblique coronal volume-rendered image shows a 1-cm-diameter angiomyolipoma in the upper pole of the right kidney (arrow).
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Figure 20. Topogram from delayed CT shows duplicate left renal pelves (large arrows) and ureters (small arrows).
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Figure 21. Oblique coronal volume-rendered image shows a small arterial branch (arrows) that arises from the superior aspect of the left renal artery and extends to the left adrenal gland.
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Copyright © 2004 by the Radiological Society of North America.
