The venous drainage of the adrenals occurs via a single vein that emerges from the anterior surface of each gland.
The dominant portion of the adrenal vein arises in the medulla of the gland. Courtesy of: Ashley Davidoff, M.D.
Adrenal venous drainage is usually through the right and left adrenal veins.
The right adrenal vein exits the apex of the gland and enters the posterior surface of the inferior vena cava. This vein is short (1-5 mm.), fragile, and the most common source of troublesome bleeding during right adrenalectomy.
The left adrenal vein is a bit longer (2-4 cm. in length) and usually drains into the left renal vein, either directly or after being joined by the left inferior phrenic vein. Smaller emissary veins may drain into the inferior phrenic, renal, and rarely the hepatic portal veins.
Not well recognized is the left inferior phrenic vein, which usually communicates with the adrenal vein which courses medially. This can be injured during dissection of the medial edge of the gland.
In this coronal view the shorter right adrenal vein can be seen entering the IVC, and the longer left vein, drains into the left renal vein. This information is very important for the angiographer who sometimes needs to sample the veins for hormonal levels. Note that the long and thin right adrenal gland has the short adrenal vein that enters directly into the IVC, while the short and stout left gland has a long vein that enters into the left renal vein.Courtesy of: Ashley Davidoff, M.D.Remember – the tall and thin one of the family (right adrenal) has the short vein, while the short and stout one (left adrenal) has the long vein. Note also that the vein of the right gland enters directly into the IVC, while the vein of the left gland enters into the left renal vein.Courtesy of: Ashley Davidoff, M.D.
Anatomy and Physiology of the Adrenal Glands: Venous Drainage – Venography
This series of three images reflects a study called “adrenal vein sampling” which requires the simultaneous catheterization of the adrenal veins. This procedure is used to identify relative and absolute concentrations of hormone secretion from the glands to distinguish between normal, bilateral hyperplasia, and unilateral adenoma.
The first image shows the catheters in each of the adrenal veins. The second image is a venogram of the right adrenal vein, and the third a venogram of the left. The venogram is mainly performed to confirm that the catheter is in the correct position, because the veins, particularly the right, may be difficult to find and other small veins coming into the IVC may masquerade as adrenal veins. It is absolutely essential to be in the “right place at the right time” for this test.Courtesy of: Ashley Davidoff, M.D.This image is an overlay and an enlarged version of the first image above. It shows the right catheter entering the short right adrenal vein, exiting from above the right gland, and entering the IVC. The left adrenal vein, which is longer, exits from below the left gland and enters into the left renal vein. The insert of the “duel” is a reminder of the short vein on the right and the long vein on the left. Courtesy of: Ashley Davidoff, M.D.This image is an overlay and an enlarged version of the second image from the initial series above. It shows the right catheter entering the shorter right adrenal vein, exiting from above the right gland, and entering the IVC. The yellow overlay is an approximation of the right adrenal gland.Courtesy of: Ashley Davidoff, M.D.This image is an overlay and an enlarged version of the third image of the initial series. It shows the left adrenal vein, which is relatively long, exiting from below the left gland, and entering the left renal vein. The yellow overlay is an approximation of the left adrenal gland.Courtesy of: Ashley Davidoff, M.D.
Anatomy and Physiology of the Adrenal Glands: Venous Drainage – Imaging CT
The left adrenal vein is almost always seen in cross sectional imaging lying at the apex of the gland. In this case both adrenal veins are identified (blue overlay). We have reviewed this case before which represents an aldosteronoma of the left adrenal gland. (green nodule)Courtesy of: Ashley Davidoff, M.D.
Anatomy and Physiology of the Adrenal Glands: Lymphatics
The left adrenal vein is almost always seen in cross sectional imaging lying at the apex of the gland. In this case both adrenal veins are identified (blue overlay). We have reviewed this case before which represents an aldosteronoma of the left adrenal gland. (green nodule) Courtesy of: Ashley Davidoff, M.D.
