EURORAD ESR

Case 3140

Adrenal incidentaloma

Author(s)
Pugliese F, Santacroce E, Martinoli C, Cittadini G Jr, Derchi LE (University of Genoa, Italy)
 
Patient
female, 37 year(s)
 
 
  • Figure 1
    Abdominal ultrasonography
     

    Longitudinal US view over the right upper quadrant. A large, inhomogenous echoic mass is seen. The lesion is localized among the liver and right kindney (L, K) (which are uninvolved) and the diaphragm (arrowheads)...

     
    Area of Interest: unknown; Imaging Technique: Abdominal ultrasonography;

    Oblique US scan over the right upper quadrant. The diaphragmatic echoic line (arrowheads) appears to be interrupted since the propagation speed of the US beam through the lesion is significantly lower than that...

     
    Area of Interest: unknown; Imaging Technique: Abdominal ultrasonography;
     
     
  • Figure 2
    5mm-thick contrast-enhanced CT
     

    Contrast-enhanced CT scan in early portal phase at the level of the right adrenal. The mass consists of a mixture of dark fat (arrow), a relatively hypodense component (arrowheads) and solid tissue (asterisk) almost...

     
    Area of Interest: unknown; Imaging Technique: 5mm-thick contrast-enhanced CT;

    CT image at a more distal level demonstrates the lesion being entirely comprised within the perirenal space (dotted line).

     
    Area of Interest: unknown; Imaging Technique: 5mm-thick contrast-enhanced CT;

    The upper pole of the right kidney (K) is preserved.

     
    Area of Interest: unknown; Imaging Technique: 5mm-thick contrast-enhanced CT;

    Contrast-enhanced CT scan in the delayed phase. No significant contrast retention is seen within the adrenal lesion. Such a behaviour makes malignancy unlikely. Note that 3 roughly different density values are...

     
    Area of Interest: unknown; Imaging Technique: 5mm-thick contrast-enhanced CT;
     
     
  • Figure 3
    8mm-thick MR scan of the abdomen
     

    Unenhanced GRE T1w MR image, in-phase TE, obtained through the right adrenal. Some foci (arrow) display MR signal of pure fat.

     
    Area of Interest: unknown; Imaging Technique: 8mm-thick MR scan of the abdomen;

    On fat-suppressed GRE T1w MR image adipose tissue (arrow) is coded dark.

     
    Area of Interest: unknown; Imaging Technique: 8mm-thick MR scan of the abdomen;

    GRE T1w technique with out-of-phase TE in order to exploit chemical shift phenomenon does not null pure adipose tissue (arrow) but microvescicular intracytoplasmic fat (arrowheads).

     
    Area of Interest: unknown; Imaging Technique: 8mm-thick MR scan of the abdomen;

    On tSE T2w image the MR signal of the medial portion of the adrenal is almost isointense to that of the spleen, resembling hematopoietic tissue (asterisks).

     
    Area of Interest: unknown; Imaging Technique: 8mm-thick MR scan of the abdomen;
     
     
  • Figure 4
    Pathological specimen
     

    Longitudinal cut through the nodular lesion arising from the right adrenal.

     
    Area of Interest: unknown; Imaging Technique: Pathological specimen;

    Note the mixed cellularity of the lesion, consisting of adipocytes and marrow elements. The diagnosis of myelolipoma was confirmed.

     
    Area of Interest: unknown; Imaging Technique: Pathological specimen;

    Adipocytes and marrow elements are seen within the gland tissue.

     
    Area of Interest: unknown; Imaging Technique: Pathological specimen;

    Note the mixed cellularity of the lesion.

     
    Area of Interest: unknown; Imaging Technique: Pathological specimen;
     
     
Longitudinal US view over the right upper quadrant. A large, inhomogenous echoic mass is seen. The lesion is localized among the liver and right kindney (L, K) (which are uninvolved) and the diaphragm (arrowheads) thus suggesting adrenal origin.
 
Oblique US scan over the right upper quadrant. The diaphragmatic echoic line (arrowheads) appears to be interrupted since the propagation speed of the US beam through the lesion is significantly lower than that occurring through the liver and kidney. This is due to the presence of adipocytes within the bulk. L= liver; K= kidney.
 
Contrast-enhanced CT scan in early portal phase at the level of the right adrenal. The mass consists of a mixture of dark fat (arrow), a relatively hypodense component (arrowheads) and solid tissue (asterisk) almost isodense to muscle.
 
CT image at a more distal level demonstrates the lesion being entirely comprised within the perirenal space (dotted line).
 
The upper pole of the right kidney (K) is preserved.
 
Contrast-enhanced CT scan in the delayed phase. No significant contrast retention is seen within the adrenal lesion. Such a behaviour makes malignancy unlikely. Note that 3 roughly different density values are simultaneously present within the lesion (arrow, arrowheads, asterisk).
 
Unenhanced GRE T1w MR image, in-phase TE, obtained through the right adrenal. Some foci (arrow) display MR signal of pure fat.
 
On fat-suppressed GRE T1w MR image adipose tissue (arrow) is coded dark.
 
GRE T1w technique with out-of-phase TE in order to exploit chemical shift phenomenon does not null pure adipose tissue (arrow) but microvescicular intracytoplasmic fat (arrowheads).
 
On tSE T2w image the MR signal of the medial portion of the adrenal is almost isointense to that of the spleen, resembling hematopoietic tissue (asterisks).
 
Longitudinal cut through the nodular lesion arising from the right adrenal.
 
Note the mixed cellularity of the lesion, consisting of adipocytes and marrow elements. The diagnosis of myelolipoma was confirmed.
 
Adipocytes and marrow elements are seen within the gland tissue.
 
Note the mixed cellularity of the lesion.
 
 
 
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