Spontaneous rupture of adrenal myelolipoma: spiral CT appearance

Russell, Christopher; Goodacre, Brian; vanSonnenberg, Eric; Orihuela, Eduardo

doi:10.1007/s002610000061

Cited by 46 publications

(20 citation statements)

References 25 publications

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“…They are usually slow-growing, non-functioning, and asymptomatic. Occasionally, large tumors or those undergoing tumor necrosis or spontaneous hemorrhage may cause flank pain [161,162]. Because these tumors contain large amounts of fat, most myelolipomas are easily recognized on CT. On CT scans, the majority of myelolipomas are well defined and measure 1-4 cm in size.…”

Section: Myelolipomamentioning

confidence: 99%

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

et al. 2014

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PET/CT with (18)F-fluorodeoxyglucose (FDG) or using different radiocompounds has proven accuracy for detection of adrenal metastases in patients undergoing cancer staging. It can assist the diagnostic work-up in oncology patients by identifying distant metastases to the adrenal(s) and defining oligometastatic disease that may benefit from targeted intervention. In patients with incidentally discovered adrenal nodules, so-called adrenal "incidentaloma" FDG PET/CT is emerging as a useful test to distinguish benign from malignant etiology. Current published evidence suggests a role for FDG PET/CT in assessing the malignant potential of an adrenal lesion that has been 'indeterminately' categorized with unenhanced CT, adrenal protocol contrast-enhanced CT, or chemical-shift MRI. FDG PET/CT could be used to stratify patients with higher risk of malignancy for surgical intervention, while recommending surveillance for adrenal masses with low malignant potential. There are caveats for interpretation of the metabolic activity of an adrenal nodule on PET/CT that may lead to false-positive and false-negative interpretation. Adrenal lesions represent a wide spectrum of etiologies, and the typical appearances on PET/CT are still being described, therefore our goal was to summarize the current diagnostic strategies for evaluation of adrenal lesions and present metabolic and anatomic appearances of common and uncommon adrenal lesions. In spite of the emerging role of PET/CT to differentiate benign from malignant adrenal mass, especially in difficult cases, it should be emphasized that PET/CT is not needed for most patients and that many diagnostic problems can be resolved by CT and/or MR imaging.

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Section: Myelolipomamentioning

confidence: 99%

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

et al. 2014

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“…In the case of bilateral myelolipomas, recommendations suggest removal of the larger and more symptomatic side and observation of the contralateral side for as long as possible to avoid lifelong supplementation of steroids [12]. The literature also demonstrates that myelolipomas can grow significantly during the observation period and a few studies have reported spontaneous hemorrhage with minor trauma in these patients [16, 17]. In our case, a bilateral adrenalectomy was performed because bilateral giant myelolipomas were present in our patient with congenital adrenal hyperplasia (CAH), with both masses growing significantly over a period of one year.…”

Section: Discussionmentioning

confidence: 99%

Giant Bilateral Adrenal Myelolipoma with Congenital Adrenal Hyperplasia

Al-Bahri

Tariq²,

Lowentritt

et al. 2014

Case Reports in Surgery

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Myelolipomas are rare and benign neoplasms, predominant of the adrenal glands, consisting of adipose and mature hematopoietic tissue, commonly discovered incidentally with increased use of radiologic imaging. Few cases of giant bilateral adrenal masses are reported, especially in the setting of congenital adrenal hyperplasia (CAH). We report the case of a 39-year-old male with a history of CAH secondary to 21-α hydroxylase deficiency on steroids since childhood, self-discontinued during adolescence, presenting with abdominal distension, fatigue, decreased libido, and easy bruising. Imaging revealed giant bilateral adrenal masses. He subsequently underwent bilateral adrenalectomy found to be myelolipomas measuring 30 × 25 × 20 cm on the left and weighing 4.1 kg and 25 × 20 × 13 cm on the right and weighing 2.7 kg. Adrenal myelolipomas are found to coexist with many other conditions such as Cushing's syndrome, Addison's disease, and CAH. We discuss the association with high adrenocorticotropic hormone (ACTH) states and review the studies involving ACTH as proponent leading to myelolipomas. Massive growth of these tumors, as in our case, can produce compression and hemorrhagic symptoms. We believe it is possible that self-discontinuation of steroids, in the setting of CAH, may have resulted in the growth of his adrenal masses.

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“…Moreover, a considerable number of ruptured tumors tend to be nonfunctional, and present with acute abdominal pain (19,21,22). Therefore, it is assumed that as the non-functional tumors grow without causing symptoms, tumors tend to undergo necrosis which can increase the risk of rupture.…”

Section: Adrenal Glandmentioning

confidence: 99%

Imaging findings of ruptured abdominal and pelvic tumors

Kim

Yang

2012

Acta Radiol

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A variety of abdominal and pelvic tumors can present with rupture leading to hemoperitoneum/hemoretroperitoneum or peritonitis. Imaging plays an important role in the diagnosis of hemorrhage or peritonitis as well as in the detection of ruptured tumors or organs. In this article, we illustrate the imaging findings of ruptured tumors arising in the abdominal and pelvic organs while excluding those of ruptured tumors arising in the stomach and intestines. It is important for the radiologists to understand the mechanisms involved in tumor rupture and recognize the imaging features of ruptured tumors according to the organs involved because this will permit the exact diagnosis of ruptured tumors, thereby facilitating prompt and effective treatment.

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Spontaneous rupture of adrenal myelolipoma: spiral CT appearance

Cited by 46 publications

References 25 publications

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

Giant Bilateral Adrenal Myelolipoma with Congenital Adrenal Hyperplasia

Imaging findings of ruptured abdominal and pelvic tumors

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