EURORAD ESR

Case 14203

Bilateral Pheochromocytoma- a Diagnostic Dilemma

Author(s)
Dr.Sivakami.R.Pradheepkumar, Assistant Professor, Department of Radiodiagnosis
Dr.Ramesh Kumar Rudrappa, HOD, Department of Radiodiagnosis
Dr.Talluri Bhavishya, PG IIIrd year, Department of Radiodiagnosis

Sri Manakula Vinayagar Medical college and Hospital , Sri Manakula Vinayagar Medical college and Hospital; Kalitheerthal Kuppam, Madagadipet, Pondicherry, India; Email:drsivakamijj@gmail.com
 
Patient
male, 24 year(s)
 
 
  • Figure 1
    Plain CT Abdomen
     

    FIGURE 1a - Plain axial CT sections showing bilateral well-defined heterogeneously hypodense lesions in adrenal region.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Neoplasia;

    FIGURE 1b - Plain axial CT sections showing bilateral well-defined heterogeneously hypodense lesions in adrenal region with the one on left showing central calcification.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Neoplasia;
     
     
  • Figure 2
    Contrast CT Abdomen
     

    FIGURE 2a - Axial CECT sections of abdomen in arterial phase showing thick irregular rim of contrast enhancement of bilateral adrenal lesions with large central non-enhancing area.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    FIGURE 2b- Axial CECT sections in early venous phase at the level of portal vein confluence showing intense thick irregular rim of contrast enhancement of bilateral adrenal lesions with large central non-enhancing...

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 3
    Contrast CT - MPR
     

    FIGURE 3a-CECT abdomen- coronal sections in early venous phase showing intense thick irregular rim of contrast enhancement of bilateral adrenal lesions with central non-enhancing area.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    FIGURE 3b- CECT abdomen- sagittal sections in early venous phase showing intense thick irregular rim of contrast enhancement of right adrenal lesion with central non-enhancing area.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    FIGURE 3c- sagittal sections in early venous phase showing intense thick irregular rim of contrast enhancement of left adrenal lesion with central non-enhancing area.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 4
    CT Contrast wash-out images
     

    FIGURE 4a- Axial CECT sections at 10 min show progressive washout of contrast of bilateral adrenal lesions.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    FIGURE 4b - Axial CECT sections at 20 min show progressive washout of contrast of bilateral adrenal lesions.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 5
    Plain and Contrast CT - Pancreatic cyst
     

    FIGURE 5a- Plain axial CT sections at the level of body of pancreas show multiple well-defined hypodense lesions in body of pancreas

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Cysts;

    FIGURE 5b- Axial CECT sections at the level of body of pancreas show multiple well-defined non-enhancing hypodense lesions in body of pancreas representing simple cysts.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 6
    Adrenal MRI - T2WIS
     

    FIGURE 6a - Axial plain MRI T2WI shows well-defined heterogeneously hyper-intense lesions in both adrenal glands.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Neoplasia;

    FIGURE 6a - Coronal plain MRI T2WI shows well-defined heterogeneously hyper-intense lesions in both adrenal glands.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Neoplasia;
     
     
  • Figure 7
    MRI- In and Out phase imaging
     

    FIGURE 7a- Axial MRI in-phase image of both adrenal lesions.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Neoplasia;

    FIGURE 7b- Axial MRI out of phase image shows no loss of signalin both adrenal lesions representing absence of intracellular fat.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Neoplasia;
     
     
FIGURE 1a - Plain axial CT sections showing bilateral well-defined heterogeneously hypodense lesions in adrenal region.
 
FIGURE 1b - Plain axial CT sections showing bilateral well-defined heterogeneously hypodense lesions in adrenal region with the one on left showing central calcification.
 
FIGURE 2a - Axial CECT sections of abdomen in arterial phase showing thick irregular rim of contrast enhancement of bilateral adrenal lesions with large central non-enhancing area.
 
FIGURE 2b- Axial CECT sections in early venous phase at the level of portal vein confluence showing intense thick irregular rim of contrast enhancement of bilateral adrenal lesions with large central non-enhancing area.
 
FIGURE 3a-CECT abdomen- coronal sections in early venous phase showing intense thick irregular rim of contrast enhancement of bilateral adrenal lesions with central non-enhancing area.
 
FIGURE 3b- CECT abdomen- sagittal sections in early venous phase showing intense thick irregular rim of contrast enhancement of right adrenal lesion with central non-enhancing area.
 
FIGURE 3c- sagittal sections in early venous phase showing intense thick irregular rim of contrast enhancement of left adrenal lesion with central non-enhancing area.
 
FIGURE 4a- Axial CECT sections at 10 min show progressive washout of contrast of bilateral adrenal lesions.
 
FIGURE 4b - Axial CECT sections at 20 min show progressive washout of contrast of bilateral adrenal lesions.
 
FIGURE 5a- Plain axial CT sections at the level of body of pancreas show multiple well-defined hypodense lesions in body of pancreas
 
FIGURE 5b- Axial CECT sections at the level of body of pancreas show multiple well-defined non-enhancing hypodense lesions in body of pancreas representing simple cysts.
 
FIGURE 6a - Axial plain MRI T2WI shows well-defined heterogeneously hyper-intense lesions in both adrenal glands.
 
FIGURE 6a - Coronal plain MRI T2WI shows well-defined heterogeneously hyper-intense lesions in both adrenal glands.
 
FIGURE 7a- Axial MRI in-phase image of both adrenal lesions.
 
FIGURE 7b- Axial MRI out of phase image shows no loss of signalin both adrenal lesions representing absence of intracellular fat.
 
 
 
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