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The clinical and pathological features of a case of malakoplakia of the adrenal gland occurring in a woman with Escherichia coli infection are described. This lesion mimicked a neoplasm, the true diagnosis only being revealed by histological examination. The light and electron microscopic features are described and it is suggested that malakoplakia is due to an abnormal macrophage response to E coli infection.
A case of a giant adrenal pseudocyst is reported. The clinico-pathological features are reviewed and a classification is proposed.
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Gray-scale B-scan was successful in delineating adrenal masses in 40 patients, all confirmed pathologically. Two patients with extra-adrenal pheochromocytomas, two calcified cysts, and two patients with bilateral adrenal hyperplasia are demonstrated. The usual ultrasonographic features are presented in this paper; they correlated well with urographic, angiographic, CT, and pathological findings. The smallest mass demonstrated was an aldosteronoma (1.3 cm in size).
Computed tomography (CT) easily and accurately demonstrates both the normal and abnormal adrenal gland. The normal adrenal gland can be seen in almost 95% of patients. With this technique, 29 of 29 proved adrenal masses were demonstrated; one case of bilateral adrenal hyperplasia could not be recognized, another showed equivocal enlargement. CT is an excellent screening and often definitive radiologic test of evaluating the adrenal gland.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Although CT should be used as the initial procedure, MRI potentially can identify most adrenal masses without the hazard of ionizing radiation or the injection of iodinated contrast material.
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PURPOSE: To retrospectively evaluate the accuracy of precontrast attenuation, relative percentage washout (RPW), and absolute percentage washout (APW) in distinguishing benign from malignant adrenal masses at multi-detector row computed tomography (CT). MATERIALS AND METHODS: This HIPAA-compliant retrospective study had institutional review board approval; the need for informed consent was waived. One hundred twenty-two adrenal masses were evaluated in 99 patients (51 men, 48 women; age range, 37-86 years) who had undergone CT performed according to the study protocol and who either were given a pathologic diagnosis or underwent follow-up imaging. Unenhanced images were obtained before administration of 120 mL of an intravenous contrast agent with a 75-second scan delay. Delayed images were obtained after 10 minutes. RPW and APW were computed. Receiver operating characteristic (ROC) analysis was performed to compare mean attenuation and both RPW and APW. Analysis was first performed with the exclusion of pheochromocytomas, myelolipomas, and cysts. Precontrast attenuation criteria specific for benignity or malignancy were determined, and ROC analysis of results for the entire nonpheochromocytoma group was then performed. RESULTS: By using an RPW of 37.5% and excluding cysts and myelolipomas, all malignant lesions were detected with a sensitivity of 100% (17 of 17 lesions) and a specificity of 95% (90 of 95 lesions). Area under the binomial ROC curve (A(z)) values were 0.912, 0.985, and 0.892 for precontrast attenuation, RPW, and APW, respectively. Precontrast attenuation of less than 0 or more than 43 HU indicated benign and malignant entities, respectively. Incorporation of these criteria into the APW analysis yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (93 of 95 lesions) for a threshold washout value of 52.0%. This attenuation-corrected APW generated the greatest A(z) value (ie, 0.988). Combining all the information available from the protocol yielded a sensitivity of 100% (17 of 17 lesions) and a specificity of 98% (98 of 100 lesions) for differentiating benign from malignant masses. CONCLUSION: Precontrast attenuation of less than 0 HU supercedes the washout profile in the evaluation of an individual adrenal mass. Noncalcified, nonhemorrhagic adrenal lesions with precontrast attenuation of more than 43 HU should be considered suspicious for malignancy.
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A transhepatic computed-tomographic-guided biopsy of a right adrenal mass is described. This method is simpler to perform than the usual posterior biopsy carried out with the patient prone and is less likely to cause a complicating pneumothorax. In seven of eight patients with right adrenal masses, adrenal tissue was obtained and an accurate diagnosis was possible. No complications resulted.
Four patients with traumatic hemorrhage in the right adrenal gland were examined with computed tomography (CT) and ultrasound (US) (initial US studies in three patients; follow-up study at least 1 month after the trauma in all patients). CT showed an enlarged inhomogeneous gland of normal to increased attenuation. This finding was associated with stranding of the periadrenal fat and stranding of the subcutaneous fat of the right flank, which corresponded to the site of trauma. US showed an enlarged, hyperechoic mass with a bright central echo that became cystic on follow-up examinations. Magnetic resonance imaging, performed in one patient, showed an enlarged gland that was isointense with liver on T1-weighted images and had increased signal intensity on T2-weighted images. Stranding of the periadrenal and subcutaneous fat of the right flank was present on T2-weighted images and appeared as streaky areas of increased signal intensity.
Three newborn infants with flank masses underwent magnetic resonance (MR) imaging after ultrasound (US) indicated adrenal hemorrhage and/or renal vein and inferior vena cava thrombosis. MR imaging was valuable in defining the hemorrhagic nature of echogenic and hypoechoic suprarenal masses and in delineating thrombi within the renal veins and inferior vena cava. Two infants with renal parenchymal damage had abnormal radionuclide scans and abnormal corticomedullary distinction on MR images. The major role of MR imaging may be in the early course of these conditions, when added diagnostic specificity is likely to affect patient management. In most instances, size of hemorrhage and intravenous clots, as well as renal size, may be accurately followed with US, while radionuclide scanning remains necessary for evaluation of renal functional impairment.