20 Questions
What is a characteristic of large adrenal carcinomas?
They can be very large and heterogeneous with cystic areas
Which primary cancer is most commonly associated with adrenal metastases?
Lung
What is a common characteristic of adrenal metastases?
They are most clinically silent
What imaging characteristic is associated with adrenal metastasis of lung carcinoma?
Tumor invasion in the inferior vena cava
Where are the adrenal glands located?
Superior and medial borders of the kidneys
What is the size of the adrenal glands?
5cm long, 2cm wide, 4cm thick
When are fetal adrenal glands known to rapidly shrink?
2-3 weeks after birth
In which fascia are the adrenal glands enclosed?
Gerota’s fascia
What does the outer cortex of the adrenal glands produce?
Cortisol, aldosterone, and androgens
Why is the left adrenal gland ultrasound more difficult?
Smaller acoustic window and gas interference
What may be detected with ultrasound in cases of adrenal hemorrhage?
Acute bright hyperechoic masses in the renal bed
What do benign neoplasms such as adenoma and myelolipoma appear as on ultrasound?
Non-specific appearances
How is right adrenal hemorrhage likely to appear on ultrasound?
Septated cystic mass with internal echoes
What is the main difference in the normal ultrasound appearances of the right and left adrenal glands?
Right appears ovoid and left appears triangular
What is the main function of the inner medulla of the adrenal glands?
Produces epinephrine and norepinephrine
Why must incidental, simple cysts in the adrenal glands be distinguished from renal, splenic, or pancreatic cysts?
Appear similar to cysts in other organs
What are the typical characteristics of adenomas on ultrasound?
Small, solid, round, and well-defined
What is the ultrasound technique for the right adrenal gland similar to?
Upper pole of the right kidney
What may be included in pathological findings of the adrenal glands?
Hemorrhage, cysts, and benign neoplasms
What is the shape of the left adrenal gland in normal ultrasound appearances?
Triangular
Study Notes
Ultrasound Imaging of the Adrenal Glands
- Adrenal glands are 5cm thick at birth, with a central fold and medial and lateral wings
- The outer cortex produces cortisol, aldosterone, and androgens, while the inner medulla produces epinephrine and norepinephrine
- Ultrasound technique for the right adrenal gland is similar to the upper pole of the right kidney
- The left adrenal gland ultrasound is more difficult due to a smaller acoustic window and gas interference
- Normal ultrasound appearances show the right adrenal gland as ovoid and the left as triangular with less echogenicity than perirenal fat
- Pathological findings may include hemorrhage, cysts, and benign neoplasms such as adenoma and myelolipoma
- Ultrasound can detect acute bright hyperechoic masses in the renal bed in cases of hemorrhage
- Right adrenal hemorrhage may appear as a septated cystic mass with internal echoes on ultrasound
- Incidental, simple cysts in the adrenal glands are uncommon and must be distinguished from renal, splenic, or pancreatic cysts
- Benign neoplasms, such as adenoma and myelolipoma, can be detected with ultrasound, but the appearances are non-specific
- Adenomas are small, solid, round, and well-defined on ultrasound
- Myelolipomas are typically hyperechoic masses in the adrenal bed, with internal hemorrhage and focal areas of calcification
Test your knowledge of ultrasound imaging of the adrenal glands with this quiz. Learn about normal ultrasound appearances, pathological findings, and distinguishing features of benign neoplasms such as adenoma and myelolipoma.
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