CT and MR imaging of acute adrenal disorders
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REVIEW
CT and MR imaging of acute adrenal disorders Amar Udare1 · Minu Agarwal2 · Evan Siegelman3 · Nicola Schieda4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The adrenal glands may be overlooked when evaluating acutely ill patients. Acute adrenal disorders may result from complications of an underlying systemic disease, which may be unsuspected clinically. Various acute adrenal emergencies including trauma, spontaneous hemorrhage, infarction and infection can be diagnosed using CT and MRI; however, in uncertain cases follow-up to resolution of imaging findings or histological sampling may be required for diagnosis. Keywords Adrenal glands · Computed tomography · Emergencies · Trauma · Magnetic resonance imaging
Introduction The adrenal glands are often involved in diseases affecting acutely ill patients, though, acute adrenal pathologies may be overlooked on imaging studies [1]. Potential causes for decreased detection of acute adrenal disorders include, but are not limited to, relative rarity of acute adrenal conditions, sometimes subtle imaging findings, rapid interpretation time requirement due to seriousness of patient illness and distracting imaging findings in other organ systems. A systematic approach which includes the adrenal glands may reduce missed imaging findings; however, consideration of * Nicola Schieda [email protected] Amar Udare [email protected] Minu Agarwal [email protected] Evan Siegelman [email protected] 1
Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa ONK1Y 4E9, Canada
2
Department of Diagnostic Imaging, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton ONL8V 1C3, Canada
3
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, MRI ‑ 1 Founders, Philadelphia, PA 19104‑4283, USA
4
The Ottawa Hospital, the University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada
relatively uncommon acute adrenal emergency conditions is required to integrate imaging findings and suggest diagnoses. Adrenal emergencies can be associated with, and often may herald a diagnosis of, an underlying serious systemic illness. This article aims to review the CT and MR imaging findings of acute adrenal emergencies with emphasis on integrating imaging findings to suggest a diagnosis, consider underlying contributing illnesses and appreciate the role for longer term follow-up imaging or histological sampling when an underlying malignancy cannot be excluded.
CT and MRI technique: making the most out of what you have Acutely ill patients are most commonly imaged with CT due to relative ease of access and patient tolerance. CT protocols vary and are often subject to the patient clinical presentation, which in the acute setting is rarely tailored for dedicated assessment of the adrenal glands. CT may be performed without contrast media (particularly in patients with acute kidney injury) or with
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