CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 38Adrenal Masses on
Computed Tomography

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GU 38-1 Cushing syndrome due to
functioning cortical adenoma. A 4-cm mass in
the left adrenal gland (arrows) is seen
posterior to the tail of the pancreas and
anterior to the kidney (K). The arrowhead
points to the normal right adrenal gland.30

4. • Fig GU 38-2 Cushing syndrome due to adrenal
hyperplasia. Although the adrenal glands are
enlarged (arrows), their normal configuration
is maintained. (K, kidneys.)30

5. • Fig GU 38-3 Cushing's syndrome due to
adrenal hyperplasia. There is thickening of the
limbs of the left adrenal gland but a normal
right adrenal gland. The prominent intra-
abndominal fat and hepatic steatosis are
typical findings in this disease.41

6. • Fig GU 38-4 Aldosteronoma. There is a well-
circumscribed left adrenal mass (arrow).41

7. • Fig GU 38-5 Adrenal carcinoma. Large soft-
tissue tumor (T) invading the anteromedial
aspect of the left kidney (K) and left crus of
the diaphragm (arrow).42

8. • Fig GU 38-6 Adrenal carcinoma causing
adrenogenital syndrome. Large mass in the
left upper quadrant (arrows) displacing the
spleen (S) anteriorly. Multiple round
metastases are present in the liver.43

9. • Fig GU 38-7 Metastasis. Huge irregular low-
attenuation mass representing an adrenal
metastasis from oat cell carcinoma of the
lung. The left adrenal gland (arrow) is normal.

10. • Fig GU 38-8 Metastases. Bilateral adrenal
metastases (arrows) in a patient with colonic
carcinoma. A large liver metastasis
(arrowheads) is also present.30

11. • Fig GU 38-9 Metastasis. Typical attenuation and washout pattern of
metastasis. (A) Unenhanced scan in a man with lung cancer shows an
enlarged left adrenal gland (arrow) with irregular margins and attenuation
of 40 HU. (B) On the dynamic enhanced phase image, there is only a
minimal increase in attenuation to 53 HU. (C) On the 10-minute delayed
image of the left adrenal gland (arrow), there is persistent enhancement
(56 HU). The lack of significant washout is consistent with an adrenal
metastasis.41

12. • Fig GU 38-10 Adenoma. Smooth, well-defined
left adrenal mass (arrow) with typical low
attenuation.41

13. • Fig GU 38-11 Adenoma. Typical attenuation and washout pattern of
adenoma. (A) Unenhanced scan in a woman with a history of breast
cancer shows a left adrenal mass (arrow) with an attenuation of 4
HU, consistent with an adenoma. (B) On the dynamic enhanced
phase image, the adrenal gland (arrow) enhances vigorously to 54
HU. (C) On the 10-minute delayed image, the attenuation of the left
adrenal gland (arrow) is 23 HU (lower than that of the normal right
adrenal gland, kidneys, and liver). The greater than 50% washout is
diagnostic of an adenoma and confirms the finding on the initial
unenhanced scan.41

14. • Fig GU 38-12 Myelolipoma. Incidentally
discovered right adrenal mass containing a
small amount of fat (arrow). Note the
calcification within the lesion.44

15. • Fig GU 38-13 Pheochromocytoma (spectrum of appearances). (A)
Unenhanced scan shows a heterogeneously attenuating mass in the
right adrenal gland (arrow). (B) Contrast scan shows a mass in the
right adrenal gland (arrow) with peripheral enhancement and a
central area of low attenuation due to necrosis. (C) Unenhanced
scan shows a mass with cystic and solid components in the left
adrenal gland. (D) Contrast scan shows a cystic adrenal lesion with a
calcified rim (arrow).45

16. • Fig GU 38-14 Ectopic pheochromocytoma. (A)
Soft-tissue mass (arrow) adjacent to the aorta
and in front of the left renal vein. (B) Scan
taken at a higher level demonstrates that both
the right and the left adrenal glands are
normal (arrows).46

17. Fig GU 38-15 Lymphoma. Bilateral adrenal masses (straight
arrows). Note the destructive lymphomatous lesion involving the
right rib (curved arrow).41

18. • Fig GU 38-16 Hemorrhage. Unenhanced scan
obtained two days after motor vehicle
accident shows an enlarged right adrenal mass
(arrow) with an attenuation value of 53 HU.
The mass was not present on CT scans
acquired at admission (not shown).41

19. • Fig GU 38-17 Hydatid cyst. Large mass filled
with daughter cysts that produce a
honeycomb appearance.47

20. • Fig GU 38-18 Lymphangioma. Lobulated cystic
mass with calcified septa.47

21. • Fig GU 38-19 Hemangioma. Scans (A) before
and (B) after contrast injection show a well-
circumscribed soft-tissue mass with punctate
calcification (arrow in A) and peripheral
nodular enhancement (arrow in B).47