Adrenal incidentaloma. Part 1. Computed tomography of adrenal incidentaloma: the possibilities and difficulties of differential diagnosis

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Abstract

The adrenal incidentaloma is a lesion of a different etiology and found incidentally in patients who underwent a diagnostic study not about the disease of this organ. Lesions can be both hormonally inactive and hormonally active, can arise from different zones of the adrenal gland or have non-specific organ affiliation, can be benign or malignant. Computed tomography characterization of these lesions, especially the differential diagnosis of benign and malignant, is extremely important for the correct diagnosis in order to provide adequate management of the patient. The article presents the key computed tomography criteria that allow radiologist to characterize the lesion most accurately and consider appropriate diagnosis.

About the authors

S. A. Buryakina

Endocrinology Research Centre; Vishnevsky National Medical Research Centre of Surgery

Author for correspondence.
Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-9065-7791

к.м.н., врач-рентгенолог, врач-рентгенолог 

Russian Federation, Moscow

N. V. Tarbaeva

Endocrinology Research Centre; Vishnevsky National Medical Research Centre of Surgery

Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-7965-9454

к.м.н., врач-рентгенолог, врач-рентгенолог

Russian Federation, Moscow

N. N. Volevodz

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-6470-6318

д.м.н., проф., зам. дир.

Russian Federation, Moscow

G. G. Karmazanovsky

Vishnevsky National Medical Research Centre of Surgery

Email: sburyakina@yandex.ru
ORCID iD: 0000-0002-9357-0998

д.м.н., проф., зав. отд-нием

Russian Federation, Moscow

L. D. Kovalevich

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0001-8958-8223

врач-рентгенолог

Russian Federation, Moscow

M. V. Shestakova

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0002-5057-127X

акад. РАН, д.м.н., проф., дир.

Russian Federation, Moscow

I. I. Dedov

Endocrinology Research Centre

Email: sburyakina@yandex.ru
ORCID iD: 0000-0002-8175-7886

акад. РАН, д.м.н., проф., дир.

Russian Federation, Moscow

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Supplementary files

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2. Figure: 1. CT, NF, axial projection. Normal image of the adrenal glands. Right adrenal gland (thin arrow), left adrenal gland (thick arrow).

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3. Figure: 2. MSCT, axial projection: a - NF; b - AF; c - WF; d - OF. Low fat adrenal adenoma (arrow). Note. MSCT - multislice computed tomography.

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4. Figure: 3. MSCT, axial projection, NF. Nodular hyperplasia: a - macronodular hyperplasia of the left adrenal gland (arrow); b - micronodular hyperplasia of the right adrenal gland (arrow).

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5. Figure: 4. MSCT, axial projection. Myelolipoma of the right adrenal gland (arrow). CT images in axial projection: a - NF; b - AF; c - WF; d - OF.

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6. Figure: 5. MSCT, axial projection. Adenoma with signs of lipomatous dystrophy.

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7. Figure: 6. MSCT, axial projection: a - NF; b - AF; c - WF; d - OF. Paraganglioma (arrow).

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8. Figure: 7. MSCT, axial projection. Adrenal cancer. CT images in axial projection: a - NF; b - AF; c - WF; d - OF. In the body of the right adrenal gland, an oval-shaped formation (arrow) with clear even contours, a heterogeneous structure due to the presence of calcifications along the periphery, is determined.

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9. Figure: 8. MSCT, axial projection. Collisional tumor of the right adrenal gland (cancer in the structure of the adenoma). CT images in axial projection: a - NF; b - AF; c - WF; d - OF. In the right adrenal gland, a rounded formation (arrow) of low density with clear even contours, a heterogeneous structure is determined due to the presence of a centrally located soft tissue inclusion that intensively accumulates a contrast agent, with its weak washout in HF and PF.

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10. Figure: 9. Metastases of clear cell kidney cancer in the adrenal glands. MSCT, axial projection, AF. Hyperdense, rounded solid formations in the bodies of both adrenal glands.

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11. Figure: 10. MSCT, axial projection. Neuroblastoma of the left adrenal gland. CT images in axial projection: a - NF; b - AF; c - WF. In the left adrenal gland, an irregularly shaped formation with zones of calcification (long arrow) and areas of necrosis (short arrow) is determined. The solid component (star) moderately accumulates contrast agent. (Images are presented with the kind permission of MD, Prof. A.V. Gorbunov and D.G. Kovalenko, State Budgetary Healthcare Institution "Morozovskaya Children's City Clinical Hospital" of the Moscow Department of Health.)

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12. Figure: 11. MSCT, axial projection: a - NF; b - AF; c - WF; d - OF. Ganglioneuroma of the right adrenal gland (arrow).

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13. Figure: 12. MSCT in frontal projection. Adrenal teratoma: a - NF; b - AF; c - WF; d - OF. In the left adrenal gland, an irregularly shaped formation (arrow) with clear, even contours, an inhomogeneous structure is determined due to the presence of a high density of calcifications, a solid component and inclusions of macrostructural fat.

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14. Figure: 13. MSCT, axial projection. Simple cyst of the left adrenal gland (arrow): a - NF; b - AF; c - WF.

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15. Figure 14. Adrenal lymphoma. MSCT, axial projection, NF (arrow).

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16. Figure: 15. Tuberculosis of the right adrenal gland. MSCT, axial projection: a - large calcifications are determined in the structure of the diffusely thickened right adrenal gland (arrow); b - diffuse hyperplasia of the left adrenal gland (arrow); c - infiltrative changes in the upper lobe of the right lung: multiple polymorphic foci with indistinct contours, pneumatization of the lung tissue in the infiltration zone is diffusely reduced by the “ground glass” type (arrow); according to the results of clinical examination, the patient was diagnosed with infiltrative tuberculosis of the right lung.

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