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Russell G, Navale P, Ludwig DR, Strnad BS, Itani M. Peripheral nodular enhancement in adrenal and renal hematomas: A report of 3 cases. Radiol Case Rep 2023; 18:3371-3375. [PMID: 37502475 PMCID: PMC10369399 DOI: 10.1016/j.radcr.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
There are a wide range of benign and malignant pathologies that the radiologist may encounter in the adrenal glands and kidneys, often incidentally when imaging is performed for other indications. Many imaging modalities including CT, MR, and US are often used in an attempt to characterize these lesions. A definitive radiological diagnosis, however, is not always possible. This is at times due to atypical presentations of typical lesions which may be mistaken for more aggressive or concerning pathologic conditions. Adrenal lesions that do not demonstrate characteristic benign imaging features might require surgical excision. Similarly, cystic renal lesions that demonstrate nodular enhancement are concerning for Bosniak IV lesions and require surgical management. We report 3 cases in 3 different patients of incidentally discovered hematomas with peripheral enhancement, 2 involving the adrenal gland and 1 involving the kidney. All 3 of these histologically proven hematomas demonstrated similar radiological manifestations of peripheral nodular progressive enhancement, mimicking neoplastic conditions, and necessitating surgical removal.
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Affiliation(s)
- Gentry Russell
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Pooja Navale
- Department of Pathology, Washington University School of Medicine, St Louis, MO, USA
| | - Daniel R. Ludwig
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Benjamin S. Strnad
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA
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Badawy M, Gaballah AH, Ganeshan D, Abdelalziz A, Remer EM, Alsabbagh M, Westphalen A, Siddiqui MA, Taffel MT, Itani M, Shaaban AM, Elsayes KM. Adrenal hemorrhage and hemorrhagic masses; diagnostic workup and imaging findings. Br J Radiol 2021; 94:20210753. [PMID: 34464549 DOI: 10.1259/bjr.20210753] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adrenal hemorrhage (AH) is a rare condition. It can be traumatic or non-traumatic. Most common causes are septicemia, coagulopathy or bleeding diathesis, and underlying neoplasms. Other reported less common causes of AH are COVID-19 and neonatal stress. Clinical diagnosis of AH is challenging due to its non-specific presentation and occurrence in the setting of acute medical illness. Therefore, most cases are diagnosed incidentally on imaging. Having high clinical suspicion in the proper clinical setting for AH is crucial to avoid life-threatening adrenal insufficiency that occurs in 16-50% of patients with bilateral AH. We discuss the clinical situations that predispose to AH, review the imaging features on different imaging modalities, highlight a variety of clinical cases, imaging features that should be concerning for an underlying neoplasm, and outline the potential role of interventional radiology in management of AH.
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Affiliation(s)
- Mohamed Badawy
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ayman H Gaballah
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | | | - Amr Abdelalziz
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | - Erick M Remer
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Mustafa Alsabbagh
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | - Antonio Westphalen
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Mohammed A Siddiqui
- Department of Radiology, University of Missouri Health care, Columbia, MO, United States
| | - Myles T Taffel
- Department of Radiology, NYU Langone Medical Center, New York, NY, United States
| | - Malak Itani
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Akram M Shaaban
- Department of Diagnostic Imaging, University of Utah, Salt Lake City, UT, United States
| | - Khaled M Elsayes
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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