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Adrenal glands

image of Adrenal glands
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Abstract

Common indications for ultrasonography of the adrenal glands include: to differentiate between primary and secondary hyperadrenocorticism; to investigate retroperitoneal or dorsal abdominal mass; to investigate hypertension or other clinical signs to which may be related to phaeochromocytomas; to search for metastasis in known cases of extra-adrenal primary malignancy. This chapter provides information on the value of ultrasonography compared with radiography and computed tomography. Imaging technique and normal ultrasonographic appearance are explained. Neoplasia, vascular invasion and atrophy are covered. This chapter contains six video clips.

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Figures

Image of 13.1
13.1 The position of the transducer for imaging the left adrenal gland with the dog in right lateral recumbency. Ultrasonogram obtained from the left window with the dog in right lateral recumbency showing the landmarks used to locate an enlarged left adrenal gland (LA). The left adrenal gland is found cranial to the left renal artery (ra) and medial to the left kidney (LK). Note the enlarged caudal pole of the adrenal gland.
Image of 13.2
13.2 The position of the transducer for imaging the right adrenal gland with the dog in left lateral recumbency.
Image of 13.3
13.3 Ultrasonogram of the normal left adrenal gland in a Cocker Spaniel. The thickness of the caudal pole is measured between the callipers and the length of the gland is indicated between the asterisks. Ultrasonogram of the left adrenal gland in an Irish Setter. The thickness of the caudal pole is measured between the callipers and the length of the gland is indicated between the asterisks. Note the elongated appearance of the gland and the adjacent phrenicoabdominal vein seen in cross-section (arrowed). LK = left kidney; ra = renal artery; rv = renal vein.
Image of 13.4
13.4 Right adrenal gland viewed from a transabdominal window. Note the ‘L’ (or pistol) shape of the gland. The thickness of the caudal pole is 7.5 mm and is measured between the callipers. The length of the adrenal gland is denoted by the asterisks. Right adrenal gland viewed from an intercostal approach. Note that the gland looks more elongated when imaged using this window. The thickness of the caudal pole is measured between the callipers and the length of the adrenal gland is denoted by the asterisks. AO = aorta; CVC = caudal vena cava.
Image of 13.5
13.5 Ultrasonogram of the normal left adrenal gland in a cat. The thickness of the caudal pole is 3.9 mm and is measured between the callipers. Adrenal glands in cats are generally uniformly hypoechoic, but in this case a corticomedullary distinction is seen. AO = aorta; LK = left kidney.
Image of 13.6
13.6 Ultrasonogram of the mineralized left adrenal gland in a cat (between the asterisks). Note the hyperechoic, hyper-reflective appearance of the adrenal gland, causing an acoustic shadow. (Courtesy of P. Mantis)
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13.7 Ultrasonograms of the bilaterally enlarged left and right adrenal glands in a dog suffering from PDH. Note that the shape of the glands is bilaterally preserved; however, both glands appear ‘plumped’. Asterisks indicate the long axis of the gland.
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13.8 Ultrasonograms of the bilaterally enlarged left and right adrenal glands in a dog treated with trilostane. The asterisks denote the long axis of the gland and the callipers indicate the caudal pole. Note the hyperechoic appearance of the caudal pole of the left adrenal gland in (a) which, in the case of trilostane treatment, may be related to intraparenchymal haemorrhage and/or hyperplasia. AO = aorta; CVC = caudal vena cava; LK = left kidney; RK = right kidney.
Image of 13.9
13.9 Ultrasonogram of a hyperechoic nodule (between the asterisks) found incidentally within the cranial pole of the left adrenal gland (between the callipers). The differential diagnoses include myelolipoma, hyperplastic nodule and neoplastic nodule (primary or metastatic). In cases of incidentally found nodules, follow-up ultrasonography of the adrenal gland is suggested.
Image of 13.10
13.10 Ultrasonogram of a large heterogeneous mass found in the region of the right adrenal gland (periphery of the mass is highlighted by the asterisks). The final diagnosis was adrenal adenocarcinoma. RK = right kidney.
Image of 13.11
13.11 Ultrasonograms of adrenal masses/nodules in (a) the left and (b) the right adrenal glands in a dog. The asterisks denote the long axis of the gland and the callipers indicate the cranial pole. The cranial pole of the left adrenal gland is deformed by a fairly isoechoic nodule. The cranial pole of the right adrenal gland is deformed by a hyperechoic nodule. The dog was asymptomatic and it was not possible to confirm a diagnosis. A repeat ultrasound examination was performed 1–3 months later to monitor the size of the lesions. AO = aorta; CVC = caudal vena cava; RK = right kidney.
Image of 13.12
13.12 Ultrasonogram of an irregularly marginated mass (arrowheads) in the region of the right adrenal gland. Doppler ultrasonography confirmed that the mass (arrowheads) was highly vascularized. Ultrasonogram showing the mass (arrowheads) invading the caudal vena cava (CVC) (arrowed). The final diagnosis was phaeochromocytoma.
Image of 13.13
13.13 Ultrasonogram of a hyperechoic thrombus (between the asterisks) causing widening of the lumen of the caudal vena cava (at the level of the callipers). Colour Doppler ultrasonogram showing absence of flow at the level of the thrombus (between the asterisks). AO = aorta; CVC = caudal vena cava.
Image of 13.14
13.14 Ultrasonograms of the bilaterally small left and right adrenal glands in a case of hypoadrenocorticism. The callipers are used to measure the thickness of the caudal pole: left adrenal gland = 2.1 mm; right adrenal gland = 2.3 mm. The asterisks indicate the long axis of the gland. CVC = caudal vena cava; LK = left kidney; RK = right kidney.

Supplements

Normal left adrenal gland in a dog.

This clip shows the left adrenal gland in an adult dog. The adrenal gland is an elongated structure, with a mildly expanded and rounded caudal pole lying to the right of the screen. Part of the abdominal aorta is seen just deep to the adrenal gland on the right of the screen, whilst part of the left kidney is seen superficial to the adrenal gland on the left of the screen. (Courtesy of F. Barr)

Normal right adrenal gland in a dog.

The right adrenal gland usually lies very close to the caudal vena cava in the cranial abdomen. In this clip the duodenum is seen running transversely across the superficial part of the image. The dark tubular structure running transversely across the image deep to the duodenum is the caudal vena cava. Deeper still the pulsation of the abdominal aorta is evident. Towards the end of the clip, the triangular hypoechoic shape of the right adrenal gland becomes evident, lying between the caudal vena cava and the aorta. (Courtesy of F. Barr)

Normal right adrenal gland in a cat.

The right adrenal gland lies very close to the caudal vena cava, but has a more cranial location in relation to the cranial pole of the right kidney compared with the dog. This clip was recorded from a right lateral window with the patient in right lateral recumbency (head to the left of the screen). The oval, hypoechoic adrenal gland can be seen adjacent to the caudal vena cava as the probe fans back and forth. The gland has multiple hyperechoic punctuate foci within it, representing a normal variation in older cats. (Courtesy of L. Gaschen)

Metastatic nodule.

A 7-year-old Yorkshire Terrier with severe generalized lymphadenopathy due to lymphoma was diagnosed with a metastatic right adrenal gland nodule. As the probe fans across the caudal vena cava in this clip, the right adrenal gland can be identified with a round, hypoechoic nodule at its caudal aspect. (Courtesy of L. Gaschen)

Left adrenal gland tumour.

An abdominal mass was palpated in the mid-abdomen of a 13-year-old Standard Poodle with polyuria and polydipsia. In this clip the abdomen is being examined with the dog in right lateral recumbency (head to the left of the screen). The probe is in a lateral position on the abdomen, pointing medially. The aorta can be seen and the adrenal gland is a large heterogeneous mass between the aorta and the transducer. Surrounding the adrenal gland mass is a large hypoechoic mass, which also extends to surround the left kidney (not shown). Surgery was performed and the kidney and adrenal gland had to be removed. The hypoechoic mass was a large haematoma due to the adrenal tumour invading the local vasculature. (Courtesy of L. Gaschen)

Phaeochromocytoma.

In this clip of a 13-year-old Shi Tzu with hypertension, the examination is performed in a transverse plane across the caudal vena cava, which can be seen as an anechoic round structure in the middle of the scan plane. The adrenal gland mass is to the bottom right of the screen. As the clip progresses, the adrenal gland mass can be seen to communicate with and invade the lumen of the caudal vena cava. (Courtesy of L. Gaschen)

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