Ultrasound Imaging of Adrenal Glands

Rumack, CM Wilson, SR Charboneau, JW = Diagnostic Ultrasound Vol.1, 4th Ed. Mosby, St. Louis Bates, JA = Abdominal Ultrasound: How, Why and When, 3rd Ed. Churchill Livingstone, Edinburgh Moore, KL Dalley, AF = Clinically Oriented Anatomy, 5th Ed. Lippincott, Williams & Wilkins Company, Canada Moore, KL Persaud, TVN = The Developing Human: Clinically Oriented Embryology, 7th Ed. Saunders, USA

Paired endocrine organs superior and medial borders of kidneys = Anatomy Enclosed with kidneys in Gerota’s fascia = Anatomy Surrounded by adipose tissue = Anatomy Level 11th/12th thoracic rib Lateral to L1 = Anatomy

More readily seen in children = Ultrasound Fetal adrenal glands large compared with kidneys - rapidly shrink 2-3 wks after birth = Ultrasound Measurements: 5cm long, 2cm wide, 4. = Ultrasound Difficult to assess with Ultrasound = Ultrasound

Lecture 11 Adrenal Glands Imaging = Course Introduction to Adrenal Glands = Course Anatomy of Adrenal Glands = Course Challenges in assessing Adrenal Glands with Ultrasound = Course

Cortisol, aldosterone, and androgens = Outer cortex Epinephrine and norepinephrine = Inner medulla Ultrasound technique for the right adrenal gland is similar to the upper pole of the right kidney = True The left adrenal gland ultrasound is more difficult due to a smaller acoustic window and gas interference = True

Right adrenal gland as ovoid and the left as triangular with less echogenicity than perirenal fat = Normal appearance Acute bright hyperechoic masses in the renal bed in cases of hemorrhage = Detectable with ultrasound Right adrenal hemorrhage appearing as a septated cystic mass with internal echoes on ultrasound = True Incidental, simple cysts in the adrenal glands are uncommon and must be distinguished from renal, splenic, or pancreatic cysts = True

Hemorrhage, cysts, and benign neoplasms such as adenoma and myelolipoma = Detectable with ultrasound Benign neoplasms, such as adenoma and myelolipoma = Non-specific appearances Adenomas as small, solid, round, and well-defined on ultrasound = True Myelolipomas as typically hyperechoic masses in the adrenal bed, with internal hemorrhage and focal areas of calcification = True

Solid mass = Irregular shape and can be very large Small mass = Homogeneous appearance Large mass = Heterogeneous with cystic areas due to haemorrhage and necrosis Adrenal metastasis = Most clinically silent and can have central hemorrhage

Adrenal cortical cancer = Solid mass with irregular shape Lymphoma = Homogeneous appearance when small Large adrenal carcinoma = Heterogeneous with cystic areas due to haemorrhage and necrosis Adrenal metastasis = Most clinically silent with potential central hemorrhage

Lung carcinoma = Most common primary source Breast carcinoma = Unilateral or bilateral with potential calcification Kidney carcinoma = Most clinically silent Thyroid carcinoma = Unilateral or bilateral with potential calcification

Common primary sources include lung, breast, kidney, and thyroid carcinomas = True Adrenal metastasis is often symptomatic = False Central hemorrhage is a rare finding in adrenal metastasis = False Calcification is a common characteristic of adrenal metastasis = False

Adrenal cortical cancer = Solid - Irregular - Can be very large - Homogeneous when small - Heterogeneous with cystic areas due to haemorrhage and necrosis as mass grows Large adrenal carcinoma = ULTRASOUND - Solid - Irregular - Can be very large - Homogeneous when small - Heterogeneous with cystic areas due to haemorrhage and necrosis as mass grows Adrenal metastases = Most common primary - lung, breast, kidney, thyroid, colon - Most clinically silent - Unilateral/bilateral - Central haemorrhage - Calcification - rare Adrenal metastasis of a lung carcinoma with tumor invasion in the inferior vena cava = Most common primary - lung, breast, kidney, thyroid, colon - Most clinically silent - Unilateral/bilateral - Central haemorrhage - Calcification - rare

Solid - Irregular - Can be very large - Homogeneous when small - Heterogeneous with cystic areas due to haemorrhage and necrosis as mass grows = Adrenal cortical cancer Most common primary - lung, breast, kidney, thyroid, colon - Most clinically silent - Unilateral/bilateral - Central haemorrhage - Calcification - rare = Adrenal metastasis of a lung carcinoma with tumor invasion in the inferior vena cava ULTRASOUND - Solid - Irregular - Can be very large - Homogeneous when small - Heterogeneous with cystic areas due to haemorrhage and necrosis as mass grows = Large adrenal carcinoma

FRD3061 Medical Imaging Science and Methods2 Ultrasound 1 Lecture 6A: Adrenals fchs.ac.ae Carcinomas = Carcinomas Adrenal cortical cancer Lymphoma Metastases FRD3061 Medical Imaging Science and Methods2 Ultrasound 1 Lecture 6A: Adrenals fchs.ac.ae ULTRASOUND – Solid – Irregular – Can be very large – Homogeneous when small – Heterogeneous with cystic areas due to haemorrhage and necrosis as mass grows = Large adrenal carcinoma FRD3061 Medical Imaging Science and Methods2 Ultrasound 1 Lecture 6A: Adrenals fchs.ac.ae Metastases = Adrenal metastasis of a lung carcinoma with tumor invasion in the inferior vena cava

Carcinomas Adrenal cortical cancer Lymphoma Metastases = FRD3061 Medical Imaging Science and Methods2 Ultrasound 1 Lecture 6A: Adrenals fchs.ac.ae Carcinomas ULTRASOUND – Solid – Irregular – Can be very large – Homogeneous when small – Heterogeneous with cystic areas due to haemorrhage and necrosis as mass grows = FRD3061 Medical Imaging Science and Methods2 Ultrasound 1 Lecture 6A: Adrenals fchs.ac.ae ULTRASOUND Most common primary - lung, breast, kidney, thyroid, colon Most clinically silent Unilateral/bilateral Central haemorrhage Calcification - rare = FRD3061 Medical Imaging Science and Methods2 Ultrasound 1 Lecture 6A: Adrenals fchs.ac.ae Metastases Adrenal metastasis of a lung carcinoma with tumor invasion in the inferior vena cava = FRD3061 Medical Imaging Science and Methods2 Ultrasound 1 Lecture 6A: Adrenals fchs.ac.ae Metastases