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Diagnostic ultrasound ( PDFDrive )

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424 PART II Abdominal and Pelvic Sonography

A

B

C

D

FIG. 11.9 Spontaneous Adrenal Hemorrhage. (A) Sagittal gray-scale and (B) color Doppler sonograms demonstrate a heterogeneous cystic

left adrenal mass with irregular appearing clot and no demonstrable vascularity. On magnetic resonance imaging (not shown) this was compatible

with hemorrhage without underlying lesion. (C) Chronic adrenal hemorrhage. Sagittal sonogram shows two echogenic foci representing clotted

blood in an enlarged right adrenal gland. (D) Acute hemorrhage. Sagittal sonogram shows a large complex mass displacing the left kidney inferiorly

and anteriorly.

Echinococcal infection of the adrenal gland manifests similarly

to echinococcal disease seen elsewhere and is most oten characterized

by cysts with varying amounts of septation, secondary

cysts, and calciication. 47,48 CMV infection of the adrenal glands

appears as hypoechoic masses that may be heterogeneous and

may contain gas if abscess formation occurs. Adrenal abscesses

typically appear as complex, avascular cystic masses.

MALIGNANT ADRENAL MASSES

Adrenocortical Carcinomas

Adrenocortical carcinomas are rare primary malignant adrenal

tumors with an estimated prevalence of 1 to 2 million worldwide.

here is a bimodal age distribution with peak incidence occurring

in children younger than 5 years or in adults in their fourth to

Causes of Adrenal Calciication

Infection

Tuberculosis

Histoplasmosis

Echinococcus

Paracoccidiomycosis

Prior hemorrhage

Neoplasm

Adrenocortical carcinoma

Myelolipoma

Pheochromocytoma

Neuroblastoma

Ganglioneuroma

Hemangioma (rare)

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