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AJR Teaching File: Incidental Adrenal Mass and Hypertension

Garrett W. Colby1, Kevin P. Banks2 and Ernesto Torres2

1 University of Alabama School of Medicine, Birmingham, AL.
2 Department of Radiology, Brooke Army Medical Center, MCHE-DR, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234.


Figure 1
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  		Fig. 1A —71-year-old woman with indeterminate left adrenal mass discovered incidentally during chest CT angiography performed for chest pain. Unenhanced abdominal CT scan illustrates well-defined 3.9-cm left adrenal mass with mixed iso- and hypodensensity. No calcifications are associated with lesion, and no adenopathy is seen. Contralateral adrenal gland is normal. Average attenuation of lesion is 27 H, prompting further evaluation with contrast material.

 

Figure 2
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  		Fig. 1B —71-year-old woman with indeterminate left adrenal mass discovered incidentally during chest CT angiography performed for chest pain. Arterial phase CT scan shows heterogeneous enhancement with mean attenuation of 44 H.

 

Figure 3
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  		Fig. 1C —71-year-old woman with indeterminate left adrenal mass discovered incidentally during chest CT angiography performed for chest pain. Axial CT scan delayed 15 minutes after administration of contrast material exhibits no substantial washout (< 50%), and average attenuation is 40 H.

 

Figure 4
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  		Fig. 1D —71-year-old woman with indeterminate left adrenal mass discovered incidentally during chest CT angiography performed for chest pain. Reconstructed tomographic image from PET illustrates increased glucose metabolism from left adrenal mass; standard uptake value is 10.5. Normal glucose metabolism is evident in kidneys, bladder, and heart. Subsequent iodine-131 metaiodobenzylguanidine (MIGB) scan (not shown) shows minimal uptake.

 

Figure 5
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  		Fig. 1E —71-year-old woman with indeterminate left adrenal mass discovered incidentally during chest CT angiography performed for chest pain. Avid activity (arrowhead) is shown in reconstructed tomographic image from indium-111 octreotide scan. Liver, spleen, and kidneys exhibit normal physiologic activity. Because tumor lies anterior to left kidney, activity associated with tumor and normal activity of upper role are superimposed on this coronal view.

 

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