adrenals and kidneys
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Adrenal MassesM- MetastasisE- Enlargement (Hyperplasia)N- Neuroblastoma
C- CarcinomaA- AdenomaM- Myelolipoma
P- PheochromocytomaOthers
Hemorrhage
Lymphoma
Ganglioneuroblastoma
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Adrenal Adenomas 1. 70% of adenomas contain highintracellular fat (lipid-rich adenomas)
and will be of low attenuation onunenhanced CT.2. Adenomas rapidly wash out contrast.
Unenhanced CT.A density equal to or below 10 HU isconsidered diagnostic of adenoma.30% of adrenal adenomas do notcontain enough intracellular lipid tohave a density of less than 10 HU andcannot be differentiated from malignant
masses on an unenhanced CT.-
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Adrenal mass workup
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adrenal adenoma MR
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Myelolipoma
Myelolipomas are benign tumorscomposed of bone marrow elements.
Usually they are easy to recognize onCT or MR because they contain areasof fat. Calcifications are seen in 20% of
cases.
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adrenal myelolipoma
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Adrenal Hyperplasia ACTH-dependent Cushing syndrome
(80-85% of cases)
Adrenal glands often symmetricallyenlarged
Limbs of adrenal gland > 10 mm
supports this diagnosis
Usually both adrenal glands involved
No discrete mass or nodule seen as
rule
Cushing syndrome can show nodularhyperplasia
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Pheo
paragangliomas arising from theadrenal medulla.
They are hormonally active in 90% of
cases. Morphologic findings on CT and MRI
include large variation in size,homogeneity, and margination of thetumours and significant enhancement inmost cases. On MRI tumours have alow SI on T1-weighted images and a
very high SI on T2-weighted images.
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pheo in bladder
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adrenal calcs
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adrenal hemorrhage
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post hemorrhagic
adrenal cyst
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adrenal mets
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adrenal carcinoma
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Renal Cystic Disease Differentiate cysts from AML and cystic
RCC using Bosniak
Autosomal Dominant Polycystic KidneyDisease (ADPKD) (Adults)
Autosomal Recessive Polycystic KidneyDisease (ARPKD) (Peds)
Medullary Sponge Kidney
Uremic Medullary Cystic Disease
Von Hippel Lindau
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Renal Cysts The Bosniak classification system, which is based on imaging
findings,can be used to differentiate benign renal cysts from
angiomyolipomas and renal cell carcinomas
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On CT hyperdense means: > 20
HU on a NECT
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enhance to 88 HUafter IV contrast
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bosniak 2
P l i C
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CalycealDiverticulum
Parapelvic Cyst
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Adult
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Adult
Polycystic
Kidney DiseaseNote the enormous kidneys filledwith both serous andhemorrhagic cysts
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PCKD
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autosomal recessive
polycystic disease
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Here is a cut section of a kidney withrecessive polycystic kidney disease
(RPKD). Note that the cysts are fairly smallbut uniformly distributed throughout the
parenchyma so that the disease is usuallysymmetrical in appearance, with both
kidneys markedly enlarged. The recurrencerisk for this disease is, of course, 25%because of the autosomal recessive
inheritance pattern. Affected babies usuallydo not survive long.
Medullary Sponge
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Medullary SpongeKidney
benign congenitaldisordercharacterized bydilatation ofcollecting tubulesin one or more
renal papillae
uremic cystic kidney
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uremic cystic kidney
disease
Multiple cystic disease occurring in thediseased kidneys of patients with end-stage renal insufficiency
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Acquired Cystic Disease This patient has Acquired Cystic Disease related to prolonged dialysis
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Von Hippel Lindau
multiple renal and pancreatic cysts,pheos
multiple and b/l RCC
retinal angiomas and cerebellar
hemangioblastomas inherited auto-dominant
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VHL
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renal TB
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Benign Neoplasms
Renal Papillary Adenoma small, incidental adenomas arising from the renal tubules
Renal Fibroma
small foci of collagenous tissue found within the pyramids
Renal Oncocytoma
appears as a well-encapsulated area of uniform signal(hypointense on T1, variable on T2) that may become very large(up to 12 cm)
frequently shows a central star-shaped scar or area of necrosis
Angiomyolipoma
benign, unifocal, expanding mass composed of an abundanceof fat, smooth muscle, and neovascularity with a tendency toform aneurysms
occurs in a bilateral, multifocal form in patients with tuberoussclerosis
Angiomyolipoma
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Angiomyolipoma
Methods for diagnosis:
Fat within the tumor is bright on non-fat-suppressed T1-weighted
images and dark on fat-suppressed images. In contrast, focal
hemorrhage appears bright regardless of fat suppression.
use chemical-shift imaging techniques: angiomyolipomas show the
characteristic India ink artifact (a rim of low signal intensity at the
interface between the tumor and renal parenchyma) on T1 -weighted
out-of-phase images.
Contrast enhancement is heterogenous and spares fatty areas.
CT w/contrast T1-MR w/gad
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Malignant Neoplasms Wilms Tumor
occurs in children, usually between the ages of 2 and5
usually appears as a large, solitary, well-circumscribed mass with occasional foci ofhemorrhage, cyst formation, and necrosis
Renal Cell Carcinoma
most characteristic finding: spherical mass of signalintensity different from adjacent normal renalparenchyma due to frequent hemorrhage and
necrosis commonly arise in the poles of the kidney
clear cell type is unifocal and large (3 to 15 cm indiameter)
papillary type is usually bilateral and multifocal
Wil T
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Wilms Tumor this large tumor may markedly displace the entire kidney
a mixture of attenuation values is seen, due to the combination of
blastemic, stromal, and epithelial tissue with occasional foci ofhemorrhage and necrosis
usually demonstrates moderate vascularity
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Renal Cell Carcinoma
The diagnosis of renal cellcarcinoma relies on contrast
enhancement. Solid malignant
tumors may immediately
enhance in density to the levelof the surrounding normal renal
parenchyma, but the density
quickly decreases.
Foci of old hemorrhage,necrosis, or simple cysts do not
enhance and maintain a low
signal intensity.
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Renal Cell Carcinoma
MRI features: Spherical shape
Fails criteria of a simple
cyst (thickened, irregular
walls with significantseptation and non-
peripheral calcification)
Lacks internal fat
Enhances with contrast
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