EURORAD ESR

Case 13933

Elevated right hemidiaphragm

Author(s)
Miguel Nogueira 1, Inês Rolla 1, Ana Catarina Silva 1 , João Pinto 2, Jorge Machado 1

1 - Radiology Department, ULS Matosinhos, Matosinhos, Portugal
2 - Pathology Department, ULS Matosinhos, Matosinhos, Portugal
 
Patient
female, 32 year(s)
 
 
  • Figure 1
    Chest X-ray

    Chest-x ray showing right hemidiaphragm elevation (yellow arrow) - more than 3 cm compared to the left.

     
    Area of Interest: Adrenals; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Pathology;
     
     
  • Figure 2
    Upper abdominal ultrasound

    Solid sub-hepatic mass with central linear calcifications which displaces downwards the right kidney. There is a thin cleavage plane with the mass.

     
    Area of Interest: Abdomen; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Pathology;
     
     
  • Figure 3
    CT

    CT shows a large heterogeneous mass centred on the right adrenal gland with central calcifications (A). It poorly enhances on portal-venous-phase and on delayed-phase (B-C). It displaces the liver upwards and the...

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 4
    MRI

    MRI shows large mass, heterogeneous on T2 and T1 weighted images due to cystic and necrotic changes (A-B), with no evidence of microscopic fat (C-D). Poorly enhanced after contrast (E-G). Shows restriction to...

     
    Area of Interest: Abdomen; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 5
    Surgical specimen - Adrenocortical carcinoma

    Adrenocortical carcinoma - the heterogeneous structure, with cystic, necrotic and hemorrhagic changes can be noted.

     
    Area of Interest: Abdomen; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Pathology;
     
     
Chest-x ray showing right hemidiaphragm elevation (yellow arrow) - more than 3 cm compared to the left.
 
Solid sub-hepatic mass with central linear calcifications which displaces downwards the right kidney. There is a thin cleavage plane with the mass.
 
CT shows a large heterogeneous mass centred on the right adrenal gland with central calcifications (A). It poorly enhances on portal-venous-phase and on delayed-phase (B-C). It displaces the liver upwards and the kidney downwards (D).
 
MRI shows large mass, heterogeneous on T2 and T1 weighted images due to cystic and necrotic changes (A-B), with no evidence of microscopic fat (C-D). Poorly enhanced after contrast (E-G). Shows restriction to diffusion (H).
 
Adrenocortical carcinoma - the heterogeneous structure, with cystic, necrotic and hemorrhagic changes can be noted.
 
 
 
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