ANOMALIES OF THE RENAL, PHRENIC AND SUPRARENAL ARTERIES: CASE REPORT

Abstract

ABSTRACT
This is a case where multiple anomalies of the posterior abdominal wall arteries were
found. These were accessory renal, a pre-hilar division of the renal, a unilateral origin
of the inferior phrenic artery from the renal and aberrant suprarenal arteries. The
accessory renal and the pre-hilar branch of the renal resembled polar arteries that
supplied the upper and lower poles and similar segments of both kidneys.
INTRODUCTION
Variations in the number of the renal arteries
and their position with respect to the renal veins are
common; and so are the variations of the suprarenal
arteries (1). Accessory renal arteries are commonly
derived from the renal, abdominal aorta, common
iliac and superior mesenteric arteries. Rarely they
originate from the external iliac, lumber, spermatic,
ovarian, inferior mesenteric, superior suprarenal,
inferior phrenic, right colic, subcostal, contralateral
renal, splenic and the thoracic aorta (2-4).
Usually a single inferior phrenic artery arises
from the abdominal aorta on each side of the body.
They might originate by a common trunk from the
aorta, the celiac trunk or independently from the
same sources. The inferior phrenic may arise from
the renal, left gastric, superior mesenteric, suprarenal;
or rarely from the hepatic artery (5-9).
The suprarenal glands are supplied by multiple
branches from the inferior phrenic, aorta and renal
arteries from above downwards (10). Rare origins
from the ureteral and gondal arteries have been
described (11).
MATERIALS AND METHODS
The findings belong to a single male German cadaver
during routine dissection in the dissection room(Anatomy
Department, College of Medicine, K.F.U., Dammam). The
subject was about 50 years old and had an average body
weight and height. He seemed to have no injuries and there
were no wounds, ulcers and or scratches on the surface
of the skin. His face, eyes, nose and mouth were normal
and there were no other congenital abnormalities apart
from those mentioned above. The cause of death could be
due to pulmonary edema or pneumonia as the right lung
looked dark black and showed multiple infracts and clots.
RESULTS
On the right side: The renal artery trifurcated into three
branches: an upper inferior phrenic artery, a middle prehilar
branch and a lower renal artery proper
(Figure 1). The inferior phrenic artery passed upwards
on the right psoas muscle to the under surface of the
right dome of diaphragm. During its course it gave
multiple aberrant inferior suprarenal arteries.
The pre-hilar branch divided into upper and lower
branches in front of the hilum of the right kidney. The
upper branch entered the upper pole of the kidney while
the lower branch passed downwards in front of the renal
artery to the lower pole of the kidney. It terminated
into two branches that entered the lower pole of the
kidney. The renal artery itself divided into three
terminal branches at the hilum of the kidney.