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British Journal of Radiology (2003) 76, 566-569
© 2003 British Institute of Radiology
doi: 10.1259/bjr/29409091
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MRI diagnosis of bilateral adrenal vein thrombosis

M F Ryan, BSc, MB, FFR RCSI, FRCR1, J P Murphy, FFR RCSI, FRCR, FRCPC2, R Jay, MD, FRCPC3, J Callum, MD, FRCPC3 and D MacDonald, MD, FRCPC4

1 Department of Clinical Radiology, Mayo General Hospital, Castlebar, Co. Mayo, Ireland, Departments of 2 Medical Imaging, 3 Medicine and 4 Clinical Pathology, Sunnybrook and Women's College Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada



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  		Figure 1. Sagittal ultrasound of the right upper quadrant, showing an enlarged heterogeneous hypoechoic right adrenal mass (arrow). The appearances were non-specific and the differential diagnosis included primary benign of malignant tumour, metastases and infection.

 


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  		Figure 2. Contrast enhanced CT scan shows an ill defined, heterogeneous, low attenuating (30 HU) nodule representing haemorrhagic infarction in the media limb of the right adrenal gland (straight arrow) and stranding in the periadrenal fat. Increased stranding is evident in the periadrenal connective tissue fat of the left adrenal gland (curved arrow).

 


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  		Figure 3. Contrast enhanced axial SPGR (spoiled gradient recalled acquisition in the steady state) T1 weighted MR scan with fat saturation, shows a non-enhancing low signal intensity mass representing deoxyhaemoglobin in the right adrenal gland (arrow).

 


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  		Figure 4. Contrast enhanced axial SPGR (spoiled gradient recalled acquisition in the steady state) T1 weighted MR scan with fat saturation, shows a filling defect that extends from the upper pole of the right adrenal gland into the inferior vena cava (curved arrow), following the expected course of the right adrenal vein. The lesion was of low signal intensity on both T1 weighted and T2 weighted sequences consistent with deoxyhaemoglobin.

 


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  		Figure 5. Contrast enhanced CT scan shows diffuse enlargement of the left adrenal gland (arrow) and increased periadrenal connective tissue stranding of the adjacent fat. The right adrenal mass lesion had resolved, but minimal periadrenal stranding persists.

 


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  		Figure 6. Axial SPGR (spoiled gradient recalled acquisition in the steady state) T1 weighted MR scan demonstrates periadrenal connective stranding evident on the left side (arrow). Complete resolution of the right adrenal mass and periadrenal connective tissue stranding was noted (not shown).

 




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