Diagnostic ultrasound ( PDFDrive )

CHAPTER 11 The Adrenal Glands 427
A
B
FIG. 11.14 Direct Invasion of the Right Adrenal Gland by Hepatocellular Carcinoma. (A) Sagittal sonogram demonstrates a large mass
with ill-deined borders extending to the suprarenal space, resulting in loss of the normal fat plane (arrows). (B) MRI of the same patient demonstrates
invasion of the right adrenal gland by the primary hepatic tumor (arrows). A small thrombus is also seen in the inferior vena cava (arrowhead).
A
B
FIG. 11.15 Adrenal Lymphoma. (A) Sagittal color Doppler sonogram shows a solid, fairly homogeneous right adrenal mass with no demonstrable
vascularity. (B) Coronal MRI of the same patient demonstrates bilateral adrenal masses (arrows). Note also splenomegaly.
uncommon in primary adrenal lymphoma but are seen more
oten in secondary adrenal lymphoma. 56 In secondary adrenal
lymphoma, concomitant lymphomatous involvement of the
kidneys, retroperitoneum, and adjacent vessels can be seen.
Treatment includes chemotherapy or radiation therapy, oten
with poor prognosis because of disease extent. In particular,
rituximab-containing chemotherapeutic agents are preferred.
Sonographic Features
Lymphomatous deposits within the adrenal gland are oten large
and homogeneously very hypoechoic with little internal architecture.
In some cases, lesions have mixed heterogeneous
echogenicity or targetoid morphology and can develop cystic
necrosis or hemorrhage. Bilateral lesions are seen in 50% to 70%
of cases 1,8,56 (Fig. 11.15).
RARE ADRENAL MASSES
Ganglioneuromas are rare benign masses of Schwann cells,
ganglion cells, and nerve ibers from the retroperitoneal sympathetic
chain coursing along the adrenal glands. 60,61 hese tumors
are most commonly incidentally found in children and young
adults and can be large in size. On ultrasound, they appear as
large heterogeneous masses with variable vascularity. Calciication