The document summarizes the anatomy, physiology, and imaging features of adrenal gland masses. It discusses incidental adrenal masses and describes the radiographic appearance of functioning tumors like pheochromocytoma and Conn's adenoma. It also covers malignant tumors such as metastases, adrenal carcinoma, and lymphoma. Pheochromocytomas appear large and heterogeneous with contrast enhancement on CT and MRI. Metastases are often bilateral, irregular, and heterogeneous. Adrenal carcinoma typically presents as a large mass with necrosis, calcifications, and heterogeneous enhancement.
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
A presentation about Adrenal gland tumors. This presentation contains 43 slides, and is divided into 3 parts :
1 - Adrenal gland tumors (Introduction).
2 - Imaging Adrenal gland tumors.
3 - Cases.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
Imaging assessment of malignant focal and diffuse liver lesions from Ultrasound to Mri with overview of interventional modalities and diagnostic snippets,
A presentation about Adrenal gland tumors. This presentation contains 43 slides, and is divided into 3 parts :
1 - Adrenal gland tumors (Introduction).
2 - Imaging Adrenal gland tumors.
3 - Cases.
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
In this presentation our agenda is
Brief introduction
Radiological Modalities
Radiological Features
Radiological Imaging Of Complications of lung cancer.
I followed Dahnert and try to describe all findings in lung cancer.
Hope it will prove an atlas in Lung cancer imaging.
In this presentation our agenda is
Brief introduction
Radiological Modalities
Radiological Features
Radiological Imaging Of Complications of lung cancer.
I followed Dahnert and try to describe all findings in lung cancer.
Hope it will prove an atlas in Lung cancer imaging.
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
Cranial Anastomoses and Dangerous Vascular Connections. Important for Neuroradiologists and Neurointerventionalists. You should know before embolization.
Embryology of the cranial circulation. Important to understand the anatomy of the cerebral circulation. Important for Neuroradiologists and Neurointerventionalists.
Cerebral Venous anatomy from the neuroradiology point of view. Anatomy of the cerebral veins and venous sinuses. Important for Neuroradiologists and Neurointerventionalists.
Anatomy of the posterior cerebral circulation from the neuroradiology point of view. Anatomy of the vertebral artery. Anatomy of the basilar artery. Important for Neuroradiologists and Neurointerventionalists.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
7. Anatomy of the Adrenal Gland
a) Arterial Supply :
-Superior adrenal artery: branch of inferior
phrenic artery
-Middle adrenal artery: branch of the aorta
-Inferior adrenal artery: branch of the renal
artery
8.
9. b) Venous Drainage :
-Each gland is drained by a single vein that
enters into the :
Inferior vena cava on the right
Renal vein on the left
10. c) Physiology :
-Cortex divided into 3 zones :
Zona glomerulosa (aldosterone)
Zona fasciculata (ACTH dependent)
Zona reticularis (cortisol)
-Medulla (epinephrine, norepinephrine)
11. d) Imaging Appearance :
-Y configuration : each adrenal gland consists of an
anteromedial ridge (body) and two posterior limbs best
seen by CT/MR
-Posterior limbs are close together superiorly but spread
out inferiorly
-Right adrenal lies adjacent to IVC throughout its extent
-Left adrenal lies adjacent to splenic vessels at its cephalad
margin
-Size :
Limbs: 3 to 6 mm thick
Length of entire adrenal: 4 to 6 cm
Width of entire adrenal: <1 cm
Weight: 4 to 5 g/gland
19. 1-Incidence :
-Is an uncommon tumor of the adrenal gland
-The tumors are said to follow a 10% rule :
10% are extra-adrenal
10% are bilateral
10% are malignant
10% are found in children
10% are familial
10 % are not associated with hypertension
20. 2-Associations :
-The majority of cases are sporadic
-In 5-10% of cases , a pheochromocytoma is a
manifestation of an underlying condition including :
a) MEN II (both MEN IIa and MEN IIb) :
-MEN IIa : medullary thyroid carcinoma ,
pheochromocytoma & parathyroid adenoma
-MEN IIb : medullary thyroid carcinoma ,
pheochromocytoma , oral ganglioneuromas & other soft
tissue tumors
b) VHL
c) Sturge-Weber Syndrome
d) TS
21. 3-Radiographic Features :
-Usually large > 5 cm with marked contrast
enhancement
-It should be noted that in patients with suspected
pheochromocytoma contrast may be
contraindicated as it could precipitate a
hypertensive crisis
a) CT :
-On CT pheochromocytomas are large usually
heterogeneous masses with areas of necrosis
and cystic change with marked contrast
enhancement
22. Pheochromocytomas in a 35-year-old woman with hypokalemia, a family history of
pheochromocytoma, and a new diagnosis of von Hippel–Lindau syndrome, axial
arterial phase (a) and coronal arterial phase volume-rendered (b) CT images,
obtained for evaluation of right upper quadrant pain, show small incidental bilateral
adrenal masses (arrow), the degree of vascularity resulted in a differential diagnosis
of metastatic hypervascular tumor or pheochromocytoma, pathologic analysis
revealed bilateral pheochromocytomas; the lesion on the right measured 2 cm, and
the two masses in the left adrenal gland measured 0.4 cm and 0.6 cm
23. Pheochromocytoma with pathologically proved hemorrhage and necrosis in a 39-year-old
woman, coronal precontrast volume-rendered (a) and axial postcontrast (b) CT
images show a large, well-defined mass with higher attenuation inferiorly that
compresses the liver and right kidney, on the contrast-enhanced image, enhancing
septa and multiple cystic areas are seen. Classically a vascular mass,
pheochromocytoma can also be cystic, particularly when the tumor is large, as in this
case
24. Pheochromocytomas in a 47-year-old woman with a history of neurofibromas
resected from both wrists who presented with abdominal pain, axial (a) and
coronal multiplanar reformation (b) images from contrast-enhanced CT
show bilateral adrenal masses (arrows), which are predominantly cystic on
the left (white arrowheads) and solid with cystic components (black
arrowheads) on the right, fine-needle aspiration performed in one mass
demonstrated a pheochromocytoma
25. Pheochromocytoma with rapid washout, axial portal venous phase (a) and
delayed phase (b) CT images show a small solid mass in the right adrenal
gland, the RPW of the adrenal nodule is 52%, a value that can be seen with
adenoma; however, the portal venous phase attenuation of 164 HU
suggests a pheochromocytoma, such high enhancement levels are not
characteristic of adenoma but are seen with some pheochromocytomas
26. Necrotic pheochromocytoma in a 42-year-old man, coronal arterial
phase (a) and venous phase (b) volume-rendered images from
contrast-enhanced CT show a large (>20 cm) hypervascular right
suprarenal mass, the mass has central necrosis and compresses
the right kidney inferiorly
27. b) MRI :
*T1 :
-Slightly hypointense to the remainder of the
adrenal
*T2 :
-Markedly hyperintense (lightbulb sign) , this is a
helpful feature
*T1+C :
-Heterogenous enhancement
c) Nuclear Medicine : MIBG
-Abnormal uptake
28. Axial T1-weighted in-phase MR image (a), out-of-phase MR image (b), and
three-dimensional GRE contrast-enhanced MR image with VIBE (c) show a
pheochromocytoma (arrow), the pheochromocytoma shows the typical
features of no loss of signal intensity on the out-of-phase image and intense
enhancement on the contrast-enhanced image
30. 1-Incidence :
-Accounts for 70 % of Conn’s syndrome
-30 % of Conn’s syndrome due to
hyperplasia which can be occasionally
nodular and mimic an adenoma
2-Radiographic Features :
-Usually small < 2 cm
-Relatively low dense
32. 1-Incidence :
-Accounts for 20 % of Cushing syndrome
-80 % of Cushing syndrome is due to
excess ACTH from pituitary tumor or
ectopic source (small cell carcinoma ,
pancreatic islet cell , carcinoid medullary
carcinoma of the thyroid & thymoma)
2-Radiographic Features :
-Usually > 2 cm in diameter
33. d) Adrenal Carcinoma :
-50 % are present as functioning tumor
-Cushing's syndrome most common clinical
manifestation
37. 1-Primary sites :
-Lung :
Small cell carcinoma : 90% of adrenal masses
detected by CT screening represent metastases
Non–small cell carcinoma : 60% of adrenal
masses
-Breast
-Kidney
-Bowel
-Ovary
-Melanoma
38. 2-Radiographic Features :
-Adrenal mass usually > 2-3 cm with
irregular margins
-Bilateral adrenal masses
-Heterogeneous enhancement
-In the presence of a known primary
malignant tumor many adrenal masses
are benign (40 % are metastases)
39. Adrenal metastases in a 61-year-old man with hepatocellular carcinoma,
axial (a) and coronal volume-rendered (b) images from contrast-enhanced
CT show primary hepatic carcinoma in the right lobe, along with large
bilateral adrenal masses, the high-attenuation components of the adrenal
lesions probably represent contrast material from prior chemoembolization
or calcifications
40. Metastatic renal cell carcinoma in a 67-year-old woman, coronal arterial
phase (a) and venous phase (b) volume-rendered CT images show
widespread metastatic disease involving the liver, lung, adrenal gland, and
bones, the liver metastases are hyperattenuating and are well seen on the
arterial phase image but become less conspicuous on the venous phase
image
41. Adrenal metastasis in a 61-year-old man with a history of left nephrectomy for
renal cell carcinoma, coronal arterial phase (a) and delayed
phase (b) volume-rendered images from contrast-enhanced CT show a
hypervascular right adrenal mass with central necrosis, a finding consistent
with pheochromocytoma or a metastasis from renal cell carcinoma, the latter
diagnosis was proved at pathologic analysis after resection; however, the
enhancement pattern is similar to that of necrotic pheochromoctyoma
44. 1-Incidence :
-50 % are present as functioning tumor
-Cushing's syndrome most common clinical
manifestation
45. 2-Radiographic Features :
-Mass usually >5 cm at time of diagnosis
-Central area of low attenuation due to
tumor necrosis
-Heterogeneous enhancement because of
areas of necrosis , hemorrhage
-50% have calcifications
-Hepatic , nodal or venous spread
46. Adrenocortical carcinoma in a 62-year-old woman with hypertension, virilization, and an enlarging
abdominal mass, coronal arterial phase (a) and venous phase (b) volume-rendered CT images
show a large left suprarenal mass with hypervascularity and necrosis on the arterial phase image
and some areas of mild enhancement on the venous phase image, the mass abuts the left
hemidiaphragm, with left pleural effusion and left lung atelectasis, and is inseparable from the left
kidney, at surgery, which included left nephrectomy, a portion of the left hemidiaphragm was
resected and the left lower lobe was partially decorticated, pathologic analysis revealed a
malignant adrenocortical neoplasm
47. Primary adrenocortical carcinoma in a 55-year-old woman, coronal volume-
rendered images from contrast-enhanced CT show a nearly 15-cm right
adrenal mass that displaces the right kidney inferolaterally and invades the
inferior vena cava (IVC) medially (arrowheads in a), tumor thrombus
extends into the intrahepatic IVC (arrows in b)
48. 61-year-old woman who presented with left lower quadrant pain, arterial phase
(A), portal venous phase axial (B), and coronal (C) images show well-
encapsulated large 13.5-cm mass lesion arising from left adrenal gland with
internal calcifications but containing no focal fat, pancreas and left kidney
are displaced by mass, but there is no evidence of invasion into adjacent
vascular structures, on resection this mass represented adrenocortical
carcinoma
49. Sagittal T1-weighted three-dimensional contrast-enhanced GRE MR image
obtained with VIBE (a) and coronal T2 obtained with half-Fourier
RARE (b) show a large mass involving the right adrenal gland, the mass
exhibits heterogeneous low signal intensity on the T1 and high signal
intensity with a heterogeneous pattern of contrast enhancement and areas
of necrosis (arrow in b) on the T2
50. c) Lymphoma :
-Lymphoma can involve the adrenal gland
secondarily or arise as a primary adrenal
tumor (uncommon)
-Lymphadenopathy will be seen elsewhere
51. Adrenal lymphoma in a 67-year-old man with an adrenal mass, imaging was
performed for diagnosis and staging, axial arterial phase (a) and coronal
arterial phase volume-rendered (b) CT images show an 11-cm mass in the
left adrenal bed, the mass invades the left hemidiaphragm, encases the
celiac and renal arteries, and displaces the aorta, the mild degree of organ
displacement despite the size of the mass and the infiltrative appearance
are suggestive of lymphoma; the diagnosis was confirmed at core biopsy
52. Axial T1-weighted in-phase (a) and out-of-phase (b) MR images show
bilateral lymphomatous deposits, the deposits have low signal
intensity, and the signal intensity does not decrease on the out-of-
phase compared with the in-phase image
56. Neuroblastoma (a, b) Coronal unenhanced T1 (a) and axial T2
obtained with inversion recovery (b) show a right adrenal tumor, the
tumor is predominantly hypointense on the T1 and has areas of
high-signal-intensity hemorrhage (arrow in a), the tumor is
hyperintense on the T2
58. a) Non-Functioning Adenoma :
-The majority of lesions are not functioning. Although CT
does not allow differentiation of functioning from
nonfunctioning masses, the presence of contralateral
adrenal atrophy suggests that a lesion may be
functioning, because pituitary adrenocorticotropic
hormone secretion is suppressed by elevated cortisol
levels
-The precontrast attenuation varies according to the
presence or absence of lipid, with mean attenuation in
the range of −2 to 16 HU in lipid-rich adenomas and
higher attenuation (20–25 HU) seen in the setting of
lipid-poor adenomas
-Lipid-poor adenomas represent 10%-40% of adenomas
-Regardless of lipid content, adenomas typically
demonstrate rapid washout, which is defined as an APW
of more than 60% and an RPW of more than 40% on
delayed images
59. -Radiographic Features :
1-CT :
-Mass 1 to 5 cm
-< 0 HU : diagnostic of adenoma (due to fat)
-0 to 10 HU : diagnosis almost certain (follow-up or MRI)
-Calcification rare
-Slight enhancement with IV contrast
-Rarely, an adenoma can hemorrhage, usually in a patient
receiving anticoagulant therapy, the presence of
hemorrhage results in regions of higher attenuation and
heterogeneity, at CT, heterogeneity and regions of
increased attenuation have been shown to correlate with
hemorrhage at pathologic analysis, before liquefaction,
the precontrast attenuation will be higher than 10 HU
60. Adrenal adenomas in a 62-year-old man with incidentally detected bilateral
adrenal nodules, clinical assessment revealed subclinical Cushing
syndrome, coronal contrast material–enhanced multiplanar reformation CT
image shows small (<2 cm) bilateral adrenal nodules, the relative
percentage washout (RPW) was more than 50% for both nodules, a finding
compatible with adenomas, follow-up CT performed 7 months later showed
stability of the lesions
61. 2.1-cm left adrenal mass was discovered incidentally on contrast-
enhanced computed tomography (CT), because the mass could not
be characterized on the contrast-enhanced CT, this unenhanced CT
was performed. It shows that the lesion (arrows) is of low
attenuation (6 HU), which is consistent with a lipid-rich adenoma
62. Lipid-poor adenoma in a 45-year-old woman who underwent CT for characterization of an
adrenal mass, axial precontrast (a), coronal portal venous phase volume-
rendered (b), and coronal delayed phase volume-rendered (c) CT images show a
well-defined left adrenal mass less than 2 cm in diameter, the attenuation
measurements were 22 HU on the precontrast image, 64 HU on the portal venous
phase image, and 26 HU on the delayed phase image, for an absolute percentage
washout (APW) of 90% and an RPW of 59%, the findings were consistent with a lipid-
poor adenoma
63. Adrenocortical adenoma with hemorrhage in a 78-year-old woman with an adrenal mass
that enlarged from 3 cm to 4 cm over 4 years, coronal pre-contrast volume-
rendered (a), coronal venous phase volume-rendered (b), and axial delayed
phase (c) CT images show a 3.2 × 3.9-cm inhomogeneous mass in the left adrenal
gland, some regions of fat attenuation are identified on the precontrast and delayed
phase images (−12 HU in c), there are central areas of higher attenuation that
measured 69 HU on the delayed phase image, with an appearance suggestive of
hemorrhage into the mass, resection revealed an adrenocortical adenoma with
central organized hemorrhage
64. Right adrenal gland shows 1.1-cm lesion measuring 8 HU on
unenhanced (A and B), 40 HU on dynamic phase (C and D), and 18
HU on 10-minute delayed phase images (E and F), these density
and washout properties are consistent with adrenal adenoma
65. 2-MRI :
-Fat-suppression techniques are used to
determine if a given lesion contains fat
(e.g., in phase/out of phase imaging , spin-
echo fat-suppression imaging) , if a lesion
contains fat , it is considered an adenoma
66. Axial in-phase (a) and out-of-phase (b) MR images show an adrenal
adenoma (arrow), which exhibits the typical decrease in signal
intensity on the out-of-phase image
67. Axial T1-weighted out-of-phase MR image shows an adrenal adenoma
(black arrow) with a focal area of high-signal-intensity hemorrhage
(white arrow)
68. **N.B. :
-Chemical shift MRI uses a technique based on
hydrogen and fat protons, which resonate at
different frequencies
-By using different time parameters during the
same MRI examination, it is possible to identify
lipid-rich adenomas
-These adenomas show signal loss on out-of-
phase imaging, as opposed to imaging when the
protons are in phase, in contrast, nonadenomas
do not show signal loss on out-of-phase imaging
69. Magnetic resonance imaging incidentally detects a 2.5-cm adrenal
mass (arrows) on (A) the in-phase image and signal dropout
on (B) the opposed out-of-phase image, these findings are
consistent with a lipid-rich adenoma
70. b) Myelolipoma :
-Very rare
-Area of obvious fat mass (low negative
attenuation)
-May enhance with contrast administration
-Calcification , 20%
71. Myelolipoma in a 40-year-old man with metastatic medullary carcinoma
of the thyroid, coronal multiplanar reformation image from contrast-
enhanced CT shows a 5-cm left adrenal mass predominantly
composed of fat (arrows), an appearance diagnostic of a
myelolipoma
72. Myelolipoma in a 31-year-old woman with an adrenal mass, which was
incidentally noted during work-up for chronic anemia and infertility,
coronal volume-rendered CT image shows a 6.5-cm right adrenal
mass composed of soft tissue and fat, an appearance consistent
with a myelolipoma
73. Myelolipoma in a 59-year-old woman with a history of long-standing hypertension, a
normal urinary metanephrine level, and no clinical evidence of hypercortisolism.
Coronal precontrast (a) and arterial phase (b) multiplanar reformation images from
contrast-enhanced CT show an 8-cm left adrenal mass containing multiple foci of fat
and punctate calcifications; there was mild enhancement on venous phase images,
after resection, pathologic analysis revealed a benign vascular lesion with adipose
tissue, findings consistent with a myelolipoma
74. (a, b) Axial T1-weighted MR images obtained without fat suppression (a) and
with fat suppression (b) show typical MR imaging features of right adrenal
myelolipoma, the fatty component of the myelolipoma (arrow in a) shows a
decrease in signal intensity on the fat-suppressed image
78. 1-Classification :
a) Endothelial cyst , 40%
b) Pseudocyst (hemorrhage) , 40% , may
contain calcified rim
c) Epithelial cyst , 10%
d) Parasitic cysts (Echinococcus) , 5%
79. 2-Radiographic Features :
-Well defined water density
-Mural calcification (15%) , especially in
pseudocysts and parasitic cysts
80. (a, b) Coronal T1-weighted in-phase (a) and T2 half-Fourier
RARE (b) MR images show an oval, well-circumscribed, right
adrenal cyst (arrow in b) with a thin wall (arrowhead in b), the cyst
has a typical appearance, showing low signal intensity at T1 and
high signal intensity at T2
81. Axial T2-weighted MR image obtained with inversion recovery shows a
left adrenal pseudocyst, note the soft-tissue component in the wall
and the posteriorly located calcification (arrow)
82. Hemorrhagic complicated adrenal cyst, (a, b) Coronal T2 obtained with
half-Fourier RARE (a) and axial contrast-enhanced VIBE
image (b) show a left adrenal mass with areas of signal intensity
similar to that of blood
84. 1-Incidence :
-More common in neonates than adults
2-Etiology :
a) Hemorrhagic tumors
b) Severe trauma
c) Anticoagulation
d) Severe stress (surgery , sepsis , burns &
hypotension)
85. 3-Radiographic Features :
a) Acute hematoma :
-High CT density (>40 HU)
-Enlarged adrenal gland
b) Old hematoma :
-Liquefaction
-Fluid-fluid level
-May evolve into pseudocyst
86. Axial unenhanced T1-weighted three-dimensional GRE MR image
obtained with VIBE demonstrates a right adrenal gland with a high-
signal-intensity rim (arrows), a finding that is consistent with
subacute hematoma
87. f) Granulomatous Disease :
-Most common causes are TB ,
histoplasmosis , blastomycosis ,
meningococcus and echinococcus
-Present as diffuse enlargement or as
discrete mass
-Can have a central cystic component with
or without calcifications
88.
89. b) Bilateral Adrenal Masses :
1-Metastases , in 15 %
2-Pheochromocytoma , in 10 %
3-Hyperplasia :
-Bilateral adrenal enlargement but usually not seen
on CT
4-Spontaneous Adrenal Hemorrhage
5-Lymphoma
6-Granulomatous Disease
90. c) Adrenal Calcification :
1-Pseudocyst , Parasitic cyst
2-Carcinoma
3-Addison Disease :
-If caused by TB , calcification is a common finding
4-Neuroblastoma
5-Granulomatous Disease
6-Pheochromocytoma
7-Myelilipoma