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Commonly encountered adrenal pseudotumours on CT

Department of Radiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan

View larger version (61K): [in a new window]   Figure 1. Right adrenal pseudotumour in a 60-year-old man with hepatocellular carcinoma. (a) Axial multidetector CT (MDCT) shows a low density (arrow) mass anterior to the upper pole of the right kidney. A small linear structure (arrowheads) suggesting adrenal gland is seen. Left adrenal metastasis (open arrow) is demonstrated. (b) Coronal reformatted MDCT image clearly demonstrates an exophitic hepatic tumour (arrow) and normal right adrenal gland (arrowhead).

View larger version (52K): [in a new window]   Figure 2. Ruptured hepatocellular carcinoma with extension to the retroperitoneum simulating right adrenal tumour in a 46-year-old man with right upper quadrant pain. (a) Enhanced CT shows tumour in the region of the adrenal gland that simulates an adrenal tumour (arrow). (b) Enhanced CT obtained 2 cm caudal to (a) shows a large perinephric haematoma (arrow). A compressed right adrenal gland (arrowhead) is seen in the medial aspect of the haematoma.

View larger version (91K): [in a new window]   Figure 3. Gastric diverticulum simulating left adrenal tumour in a 43-year-old man with hypertension. (a, b) Axial images of enhanced multidetector CT (MDCT) with oral contrast shows a mass (arrow) of heterogeneous attenuation in the left supra renal region. A linear structure (arrowhead) suggesting left adrenal gland is demonstrated in the lowest cut of the mass. (c) Coronal T1 weighted MR image with positive oral contrast clearly demonstrates diverticulum of the gastric fundus (arrow).

View larger version (63K): [in a new window]   Figure 4. Dilated colon simulates left adrenal tumour in a 65-year-old man with rectal carcinoma. (a) Axial multidetector CT (MDCT) shows low density mass (arrow) in a left suprarenal region suggesting adrenal tumour. Of note is low density liver metastases (arrowheads). (b) Axial MDCT obtained caudally to (a) demonstrates that the low density mass is a part of the dilated fluid-filled colon (arrow).

View larger version (94K): [in a new window]   Figure 5. Left adrenal pseudotumour due to splenic lobulation in a 72-year-old woman with right pleural mesothelioma. (a) Axial CT image suggests a mass of the left adrenal gland (arrow). (b) Axial thin slice (3 mm) images demonstrate the mass is a part of the lobulated spleen (arrow). (c) Oblique coronal volume rendered image of CT clearly demonstrates the lobulated spleen (arrow) close to the left adrenal gland (arrowhead).

View larger version (59K): [in a new window]   Figure 6. Left adrenal pseudotumour due to dilated portosystemic veins in a 54-year-old man with portal hypertension due to cirrhosis. (a) Axial CT image shows large tubular varix in left suprarenal region. There is a possible left adrenal mass (arrow) that shows slightly less intense enhancement than the surrounding varices. (b) T2 weighted MR image demonstrate "flow void" in the mass (arrow) as well as surrounding varix, indicating flowing blood in the varix.

View larger version (69K): [in a new window]   Figure 7. Pseudotumour of the left adrenal gland due to left upper pole renal cyst in a 56-year-old woman with liver and right adrenal gland metastasis. (a) Axial CT image suggests a cyst (arrow) in the suprarenal area in the posterior aspect of the left adrenal gland (arrowhead). Hepatic metastasis from breast carcinoma invades the right adrenal gland (open arrow). (b) Coronal reformatted CT image demonstrates the cyst of the upper pole of the left kidney with beak sign (arrow).