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Adrenal Glands

Imaged for 1. Hormonal Hyperfunction, 2. Metastasis from lung, 3. Incidentaly Anatomy: Cortex: cortisol, aldosteron, androgens, estrogens Medulla: catecholamines triangular, V or Y shaped Incidentaloma: adrenal mass found incidentally, 5% of patients undergoing MDCT DDX of Incidentaloma: Benign nonfunctioning adrenal Adenoma, Metastasis, Pheochromocytoma, Functioning Adenoma, Myelolipoma, Adrenal Carcinoma, Hemorrhage, Cyst or Pseudocyst, Neuroblastoma, Ganglioneuroma Mimickers of incidentaloma: Tortuous splenic vessels, Splenic lobulations, Pancreatic projections, Exophytic upper renal masses, Portosystemic venous collaterals, Retroperitoneal adenopathy, Gastric diverticulum Masses: Adenoma: intracellular fat - Chemical shift MR, <4cm, most common adrenal mass, 70% lipid-rich adenomas (HU: <10), 30% lipid-poor adenomas; HU: -20 to 30; stability over time; rapid washout of contrast Metastasis: 27% pt w/ lung, breast, melanoma, GI, thyroid and renal malignancy; inhomogeneous density, irregular shape, thick irregular margination, internal hemorrhage, necrosis, invasion; HU: >10 Pheochromocytoma: rule of 10: 10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial, 10% incidental; MEN II, VHL, neurofibromatosis; spontaneous hemorrhage; solid, complex, predominantly cystic; MR lightbulb on T2; extra-adrenal sites: organ of Zuckerandl, the bladder and the para-aortic sympathetic chain Myelolipoma: bng, macroscopic fat - dark on CT, HU: -30 to -100 and hematopoietic bone marrow elements, calcifications in 20% Adrenal Carcinoma: >4cm, hyperfunctioning, Cushing, Conn, virilization, feminization; large mass with central necrosis and hemorrhage, irregular enhancement, calcs in 30%; hepatic and lymph node mets, renal vein or IVC tumor thrombus Lymphoma: retroperitoneal lymphoma may totally encase the gland Collision tumor: mets into adrenal adenoma Cysts: well-marginated, non-enhancing, homogeneous, fluid containing Pseudocysts: sequela of previous hemorrhage, hypodense mass w/ septations, fluid-fluid level, cacifications Hemorrhage: newborn, tumor, coagulopathy, trauma (unilateral on the right side); oval hyperdense mass with periadrenal fat stranding Adrenal Hyperplasia: limbs of gland are longer than 5 cm, and thicker than 10mm, may be nodular; DDX: mets, granulomatous disease (TB, Histoplasmosis)