Diagnostic Ultrasound - Abdomen and Pelvis
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Diagnostic Ultrasound - Abdomen and Pelvis

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09.07.2019 Views

Adrenal Hemorrhage (Left) Longitudinal transabdominal ultrasound shows a very hypoechoic right suprarenal lesion with lowlevel internal echoes st, compatible with evolving hematoma. Note the complex intrahepatic collection . (Right) Axial CECT in the same patient shows a nonenhancing, hypodense right adrenal lesion with irregular enhancement of the lateral limb of the gland st. Note the surrounding periadrenal fat infiltration ſt, hepatic contusion , and perihepatic fluid in this patient post trauma. Diagnoses: Adrenal Gland (Left) Transverse transabdominal ultrasound in a patient after a motor vehicle collision shows a welldemarcated hypoechoic right adrenal lesion with lowlevel internal echoes st. (Right) Coronal CECT in the same patient shows a nonenhancing oval hypodense lesion in the right adrenal gland. Note focal preservation of normal adrenal enhancement st along the medial peripheral margin. Illdefined periadrenal fluid tracks to the perirenal space ſt. (Left) Axial NECT shows a well-circumscribed, oval left adrenal lesion with heterogeneous density. Note the well-defined peripheral rim st with central low attenuation and layering hyperdense debris level ſt. (Right) Axial T2 HASTE MR shows a well-defined left adrenal lesion with a T2-dark rim ſt characteristic of chronic hemorrhage. Note the T2-hyperintense internal contents with layering T2-dark debris st. 587

Myelolipoma Diagnoses: Adrenal Gland TERMINOLOGY • Definition: Rare benign tumor consisting of macroscopic fat interspersed with hematopoietic elements IMAGING • Appearance varies depending on admixture of fatty and soft tissue components • US typically shows homogeneously hyperechoic mass, but it may be heterogeneous iso- or hypoechoic • CT typically shows well-defined, heterogeneous mass with macroscopic fat that is diagnostic • MR characterizes intratumoral fat best on fat-suppressed sequences TOP DIFFERENTIAL DIAGNOSES • Adrenal hemorrhage • Pheochromocytoma • Liposarcoma • Renal angiomyolipoma KEY FACTS • Adrenal adenoma • Adrenal metastases PATHOLOGY • Contains mature fat cells with variable mixture of myeloid cells, erythroid cells, and megakaryocytes CLINICAL ISSUES • Usually found incidentally • Clinical signs are usually absent except in rare cases of hemorrhage and rupture DIAGNOSTIC CHECKLIST • Confirm that fat-containing lesion arises from adrenal gland and not adjacent organs or retroperitoneum • Adrenal mass with discrete focus of macroscopic fat is virtually diagnostic of myelolipoma (Left) Longitudinal ultrasound of a myelolipoma shows a lobulated, well-defined, heterogeneously hyperechoic mass ſt above the right kidney . (Right) Coronal CT demonstrates a heterogeneous, encapsulated, suprarenal mass containing ill-defined, "smoky" soft tissue elements ſt and macroscopic fat st. (Left) Axial T1 MR shows an encapsulated, unilateral, left adrenal mass containing heterogeneous components. Central soft tissue shows central T1 hypointensity ſt, while peripheral intratumoral fat shows T1 hyperintensity st. Note the normalappearing right adrenal gland . (Right) Axial T1 MR with fat saturation shows signal drop of the retroperitoneal fat and in the peripheral components of the mass st, confirming the presence of intratumoral fat. Note the normal-appearing right adrenal gland . 588

Adrenal Hemorrhage<br />

(Left) Longitudinal<br />

transabdominal ultrasound<br />

shows a very hypoechoic right<br />

suprarenal lesion with lowlevel<br />

internal echoes st,<br />

compatible with evolving<br />

hematoma. Note the complex<br />

intrahepatic collection .<br />

(Right) Axial CECT in the same<br />

patient shows a<br />

nonenhancing, hypodense<br />

right adrenal lesion with<br />

irregular enhancement of the<br />

lateral limb of the gl<strong>and</strong> st.<br />

Note the surrounding<br />

periadrenal fat infiltration ſt,<br />

hepatic contusion , <strong>and</strong><br />

perihepatic fluid in this<br />

patient post trauma.<br />

Diagnoses: Adrenal Gl<strong>and</strong><br />

(Left) Transverse<br />

transabdominal ultrasound in<br />

a patient after a motor vehicle<br />

collision shows a welldemarcated<br />

hypoechoic right<br />

adrenal lesion with lowlevel<br />

internal echoes st.<br />

(Right) Coronal CECT in the<br />

same patient shows a<br />

nonenhancing oval hypodense<br />

lesion in the right adrenal<br />

gl<strong>and</strong>. Note focal preservation<br />

of normal adrenal<br />

enhancement st along the<br />

medial peripheral margin. Illdefined<br />

periadrenal fluid<br />

tracks to the perirenal space<br />

ſt.<br />

(Left) Axial NECT shows a<br />

well-circumscribed, oval left<br />

adrenal lesion with<br />

heterogeneous density. Note<br />

the well-defined peripheral<br />

rim st with central low<br />

attenuation <strong>and</strong> layering<br />

hyperdense debris level ſt.<br />

(Right) Axial T2 HASTE MR<br />

shows a well-defined left<br />

adrenal lesion with a T2-dark<br />

rim ſt characteristic of<br />

chronic hemorrhage. Note the<br />

T2-hyperintense internal<br />

contents with layering T2-dark<br />

debris st.<br />

587

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