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Everything you need to know about Computed Tomography (CT) & CT Scanning

Adrenal: Adrenal Calcification Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Adrenal ❯ Adrenal Calcification

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  • Adrenal Calcification (thin calcified limbs)
    - TB
    - Histoplasmosis
    - Wolman’s Disease
  • Adrenal Calcification: Masses
    - Myelolipoma
    - Adrenal hemorrhage
    - Adrenal cortical carcinoma
    - Neuroblastoma
    - Metastases
    - Pheochromocytoma
    - Hemangioma
    - Adrenal mature teratoma
  • “With the widespread use of computed tomography (CT), it is not unusual to find calcification within the adrenal glands. There are a variety of adrenal lesions that may calcify, but usually the appearance of the calcification is not specific. However, when the pattern and morphology of the adrenal calcification are combined with the other imaging features and the appropriate clinical history, the correct diagnosis may be suggested.”
    Adrenal gland and adrenal mass calcification
    Hindman N, Israel GN
    Eur Radiol (2005) 15: 1163–1167
  • Adrenal Calcifications: Benign
    - prior hemorrhage
    - secondary to infection such as histoplasmosis, tuberculosis,
    - bilateral atraumatic hemorrhage in the setting of septicemia, leading to adrenal insufficiency (Waterhouse–Friderichsen syndrome)
    - amyloidosis
    - tumors like myelolipoma and pheochomocytoma
  • Adrenal Calcifications: Malignant
    - Adrenal cortical carcinoma
    - Pheochromoctoma
    - Rare metastases
  • “Centrally located intratumoral microcalcifications are seen in approximately 19%–33% of adrenal cortical carcinomas. Statistically, when evaluating an adrenal mass larger than 4 cm with internal macroscopic fat and no definite invasive features, differentiation between a benign myelolipoma and a fat-containing adrenal cortical carcinoma is difficult, and the presence of calcification in the mass is not helpful.”
    Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis
    Maria Zulfiqar et al.
    RadioGraphics 2020; 40:731–753
  •  CT is the most sensitive imaging modality for the purpose of calcium detection in the abdomen and pelvis. A dropped stone in the peritoneal cavity, for example from the gallbladder or appendix after perforation or during surgery, is a potential nidus for infection, sometimes causing diagnostic misperception. If calcification is found in an untreated HCC in a young adult without cirrhosis, the tumor will most likely be of the fibrolamellar variety.
    Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis
    Maria Zulfiqar et al.
    RadioGraphics 2020; 40:731–753
  • A central sunburst or stellate pattern of calcification associated with a scar in a multilocular microcystic pancreatic lesion in an older woman is pathognomonic for a serous cystic tumor. A solid renal mass containing macroscopic fat and coarse calcifications is suspicious for renal cell carcinoma and should not be confused with an angiomyolipoma.
    Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis
    Maria Zulfiqar et al.
    RadioGraphics 2020; 40:731–753
  • “Up to 30% of renal cell carcinomas demonstrate calcification. Therefore, any calcified renal mass, regardless of the characteristics of the calcification, should raise the possibility of a malignant neoplasm. Rarely, macroscopic fat and calcification are seen concomitantly in renal cell carcinomas that arise due to osseous metaplasia of the nonepithelial stromal component of the tumor. Although macroscopic fat within a renal mass is almost pathognomonic for an angiomyolipoma, calcifications in renal angiomyolipomas are uncommon. A solid renal mass containing macroscopic fat and coarse calcifications is suspicious for renal cell carcinoma and should not be confused with an angiomyolipoma."
    Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis
    Maria Zulfiqar et al.
    RadioGraphics 2020; 40:731–753
  • “Vascular and end-organ calcifications are benign but tend to be extensive and highly prevalent in patients with diabetes and ESRD, occurring decades prematurely in this population than in the general population. Dramatic acceleration is noted once the patients transition to dialysis. The prevalence and degree of calcification independently correlate with future cardiovascular events and patient mortality. Vascular aneurysms show a rim pattern of calcification, aiding in detection on radiographs and nonenhanced CT images. Similarly, calcified intima in an aortic dissection flap helps in diagnosis at nonenhanced CT. An intraluminal eccentric pattern of calcification along the inner walls of large veins represents sequela of chronic thrombosis.”
    Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis
    Maria Zulfiqar et al.
    RadioGraphics 2020; 40:731–753

  • Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis
    Maria Zulfiqar et al.
    RadioGraphics 2020; 40:731–753

  • Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis
    Maria Zulfiqar et al.
    RadioGraphics 2020; 40:731–753
  • Purpose: The aims of the study were to assess the typical and atypical radiologic features of pathologically proven adrenal adenomas and to determine the relationship between the radiologic and histopathologic classification.
    Conclusions: Radiologically atypical lesion was significantly associated with larger size and higher unenhanced CT attenuation. Approximately 27% of the cases demonstrated atypical features on imaging. Most radiologically atypical adrenal adenomas are pathologically typical.
    Preresection Radiologic Assessment and Imaging Features of 156 Pathologically Proven Adrenal Adenomas
    Sherif B. Elsherif et al.
    J Comput Assist Tomogr 2020;44: 419–425
  • “In summary, adrenal adenomas can have typical and atypical imaging features, but most radiologically atypical adenomas are typical on histopathologic analysis. In addition, there is no association between the radiologic and pathologic classification of adrenal adenomas.”
    Preresection Radiologic Assessment and Imaging Features of 156 Pathologically Proven Adrenal Adenomas
    Sherif B. Elsherif et al.
    J Comput Assist Tomogr 2020;44: 419–425
© 1999-2020 Elliot K. Fishman, MD, FACR. All rights reserved.