Non-masslike Adrenal Abnormalities

In this video lecture, we discuss the normal imaging appearance of the adrenal glands, as well as multiple common and rare non-masslike adrenal abnormalities on CT and MRI.

Key points include:

• The adrenal glands normally have an inverted “V” or “Y” configuration.
• A linear, disk-like adrenal gland or “pancake” adrenal gland indicates congenital malposition or absence of the ipsilateral kidney.
• Adrenal hyperenhancement raises suspicion for developing shock and may signal a therapeutic window to act upon.
• Adrenal calcifications can be caused by prior hemorrhage, infection, tumors and metabolic syndromes.
• On MRI, T1-weighted in-phase GRE images can be helpful in identifying calcification due to dark blooming caused by susceptibility artifact.
• Adrenal atrophy may indicate adrenal insufficiency.
• Adrenal hyperplasia is identified when adrenal limbs measure greater than 10 mm in thickness and may or may not be hormonally functioning.
• Nonhemorrhagic adrenal infarction appears as a nonenhancing, edematous adrenal gland with surrounding stranding and restricted diffusion.
• Adrenal infarction can be seen in hypercoagulable states, antiphospholipid-antibody syndrome and pregnancy.

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