Diagnostic ultrasound ( PDFDrive )

422 PART II Abdominal and Pelvic Sonography
A
B
C
FIG. 11.7 Adrenal Pheochromocytoma. (A) Sagittal
gray-scale and (B) color Doppler sonograms show a
cystic and solid, well-circumscribed, left adrenal mass.
(C) Computed tomographic scan demonstrates an enhancing
heterogeneous mass (arrow) with cystic components, and
luid-luid levels representing hemorrhage or necrosis.
of cystic lesions include thickened wall or septations, or internal
vascularity.
Cystic Adrenal Lesions
Pseudocyst
Endothelial cyst
Epithelial cyst
Infection (echinococcus, abscess)
Necrotic neoplasm
Cystic pheochromocytoma
Lymphangioma
Adrenal hemorrhage
Adrenal Hemorrhage
Adrenal hemorrhage is bilateral in 20% of cases. his is most
commonly associated with anticoagulation use, trauma,
postoperative status from surgery, postprocedure ater adrenal
venography, sepsis, or burns. In rare cases, spontaneous adrenal
hemorrhage has been associated with meningococcal septicemia
known as Waterhouse-Friderichsen syndrome. In the context
of trauma, adrenal hemorrhage oten suggests traumatic injury
to other solid abdominal organs. Bilateral adrenal hemorrhage
predisposes for adrenal insuiciency. 41 Adrenal hemorrhage can
sometimes be associated with an underlying lesion, which can
be diicult to ascertain in the acute setting. An underlying lesion
may be suspected in cases of intralesional enhancement on MRI
or metabolic activity on 18 FDG-PET CT. 40
Sonographic Features
In the acute setting, adrenal hemorrhage can appear solid and
difusely or heterogeneously echogenic. he hemorrhage becomes
progressively heterogeneous in echogenicity with time, and
chronic hematomas can have central cystic components. Calciication
can also occur in the chronic setting. Adrenal hemorrhage
is avascular on Doppler interrogation. 42 (Fig. 11.9).