Concentric-ring sign in adrenal hemorrhage
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ENDOCRINE IMAGING
Concentric-ring sign in adrenal hemorrhage Takafumi Taguchi • Keiji Inoue • Yoshio Terada
Received: 10 February 2014 / Accepted: 21 February 2014 Ó Springer Science+Business Media New York 2014
Keywords Adrenal hematoma Idiopathic adrenal hemorrhage A 30-year-old man with back pain and hypertension with no history of trauma or coagulopathy was referred to our hospital. A subsequent surveillance CT scan of the abdomen showed enlargement of the left adrenal gland. Weighted MRI showed an isointense mass (Fig. 1a, white arrowhead) surrounded by an area of bleeding (Fig. 1a, black arrow) on T1-weighted imaging consistent with adrenal hematoma with partial rupture on arrival. Adrenal hormone levels and all tumor markers were within normal limits. Abnormal accumulation was not detected both in F-18 fluorodeoxyglucose positron emission tomography/ computed tomography and 131I-metaiodobenzylguanidine scintigraphy. One month later, a unique MR appearance termed ‘‘concentric-ring sign’’ was seen, which appears as a mass lesion with a dark peripheral rim (Fig. 1b, black arrowhead) surrounding a bright ring (Fig. 1b, white
arrowhead) on T1-weighted image. The center of the mass lesion appeared homogeneous with intensity slightly greater than muscle. Four months later, the patient’s adrenal gland showed marked reduction in size, and the concentric-ring sign had disappeared. This characteristic concentric-ring sign and the dynamic size change of the adrenal gland suggest idiopathic adrenal hemorrhage without neoplastic findings. Concentric-ring sign is usually defined as a lesion with a thin and dark peripheral rim with a bright inner ring most distinctive on T1-weighted images, which helps establish the diagnosis of chronic hematomas [1, 2]. The finding usually appears *3 weeks after the onset of hemorrhage [1]. In the diagnosis of adrenal tumors, concentric-ring sign is an important differential finding to confirm adrenal hemorrhage or hematoma, and clinicians should be aware that repeated short-term MRI evaluations are needed. Disclosures
No competing financial interests exist.
T. Taguchi (&) Y. Terada Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku 783-8505, Japan e-mail: [email protected] K. Inoue Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku 783-8505, Japan
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Endocrine Fig. 1 MRI scans of the abdomen showing the concentric-ring sign and the change in the size of the adrenal glands. Patient’s left upper abdomen with an adrenal hematoma (a, white arrowhead) with partial rupture (a, black arrow) showing isointensity on T1-weighted imaging on the patient’s arrival (a, white arrow head) and concentric-ring appearance with a dark peripheral rim (b, black arrowhead) surrounding a bright ring (b, white arrowhead) on T1-weighted image after 1 month (b)
B
A
On arrival
References 1. P.F. Hahn, S. Saini, D.D. Stark, N. Papanicolaou, J.T. Ferrucci Jr, Intraabdominal hematoma: the c
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