A New Approach to Ultrasound Study of the Left Adrenal Lodge

Ultrasound examination of the left adrenal gland is generally associated with relatively low sensitivity and specificity. It is strongly influenced by the operator’s experience, patient characteristics, and the type of equipment available. In particular, the left adrenal gland remains a structure that is diffcult to investigate, even for experts. Therefore, we aimed to improve the ultrasound explorability of the left adrenal gland and, thus, contributing to enhancing the overall diagnostic sensitivity of the technique, allowing for a more widespread application by the addition, alongside traditional structural landmarks, of vascular landmarks. The vascular landmarks are represented by 1) the abdominal aorta at the level of the emergence of the superior mesenteric artery, 2) the splenic vein, and 3) the vascular pedicle of the left kidney. The adrenal gland is located in the space between the aorta medially, the renal pedicle caudally, and the splenic vein anteriorly. Therefore, with a left paramedian axial section, the abdominal aorta is sought at the level of D12, where the superior mesenteric artery originates. Aligning with the splenic vein, which acts as the roof of the space under examination, the area of interest is explored by tilting the probe superiorly and medially towards the aorta, inferiorly and medially towards the left renal vein, and superiorly and laterally towards the renal border, trying to maintain the view of the splenic vein as the true anterior-lateral margin of the area. In cases where the conditions allow for accurate visualization and measurement of the lesion, ultrasound may be preferred over CT for long-term surveillance, especially in young individuals, due to its lack of radiation exposure, simplicity, and lower cost.