1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Eduardo Escobar Affiliation: Walter Reed Army Medical Center

2. MedPix No: 8537 - History Pt Demographics: Age = 49 y.o. Gender = woman Well nourished, well developed woman with incidental finding from chest CT. Downloaded by (-1)

3. MedPix No: 8537 - EXAM & LABS Normal

4. Bilateral Adrenal Adenoma - Dynamic CT Non-contrast CT reveals bilateral ovoid low attenuation masses in the location of the adrenal glands. The right adrenal mass is not clearly shown on this image; but, it was also enlarged. Downloaded by (-1)

5. Bilateral Adrenal Adenoma - Dynamic CT Early phase of contrast CT reveals bilateral enhancing masses in the adrenal glands. The right adrenal mass is not clearly seen on this image but it was enlarged. Both masses had homogeneous enhancement. Houndsfield units were approximately fifty. Downloaded by (-1)

6. Bilateral Adrenal Adenoma - Dynamic CT Delayed phase from contrast CT reveals bilateral enhancing masses in the adrenal glands which revealed more than 50% wash out of enhancement from previous phase of 50 HU of attenuation now reduced to 14 HU. Downloaded by (-1)

7. FINDINGS Non contrast images revealed a mass in the left and right adrenal glands with low attenuation based upon Houndsfield units. The glands demonstrated a well circumscribed appareance, no peripheral calcifications and homogeneity through out the mass tissue. Upon contrast administration the gland enhanced and then on the delayed images, showed a wash out that was greater than 50%. Therefore, based on this findings, the lesions can be characterized as adrenal adenomas.

8. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? Adrenal Adenoma - Adrenal Hemorrhage - Adrenal hyperplasia - Pheochromocytoma - Adrenal Carcinioma (Rare) - Adrenal Cysts (Rare) - Adrenal Infection (e.g. Tuberculosis) - ACTH Secreting Tumor (e.g. Cushing Syndrome)

9. Diagnosis: Adrenal Adenoma Dx Confirmed by:

10. DISCUSSION http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm