Elsevier

Clinical Imaging

Volume 39, Issue 5, September–October 2015, Pages 911-913
Clinical Imaging

Case Report
Adrenal tuberculosis mimicking a malignancy by direct hepatic invasion: emphasis on adrenohepatic fusion as the potential route

https://doi.org/10.1016/j.clinimag.2015.04.019Get rights and content

Abstract

A 64-year-old female with primary adrenal insufficiency presented with a right adrenal mass showing quantitative nonadenoma features on dedicated adrenal computed tomography (CT). CT showed direct invasion of the mass to the adjacent hepatic parenchyma, and high uptake was noted on 18F-fluorodeoxyglucose positron emission tomography/CT. Laparoscopy revealed gross invasion of the adrenal lesion into the liver, which led to the en bloc resection including the involved liver. Polymerase chain reaction analysis of the surgical specimen revealed adrenal tuberculosis.

Section snippets

Case report

A 64-year-old female presented with general weakness for 2 months. The laboratory tests revealed primary adrenal insufficiency [i.e., hyponatremia, 128mmol/l; high adrenocorticotropic hormone (ACTH), 1026 pg/ml; no appropriate increase of cortisol in the rapid ACTH stimulation test]. The dedicated adrenal computed tomography (CT), which consisted of unenhanced CT, and 1-mine and 15-min enhanced CT, was performed to evaluate the adrenal gland.

CT images showed a soft tissue mass, measuring 3.2

Discussion

Typical radiologic features of the adrenal tuberculosis include bilateral enlargement of the adrenal glands showing peripheral enhancement and central necrotic areas, with or without calcifications [1], [2], [3]. As the disease advances, normal adrenal tissues are more destroyed, resulting in adrenal insufficiency. In addition, concurrent or previous extra-adrenal involvement such as pulmonary tuberculosis may be helpful for the diagnosis of adrenal tuberculosis [4]. When these typical

Conclusion

In conclusion, the adrenal tuberculosis may invade the adjacent liver when it occurs in right adrenal gland because the adrenohepatic fusion may exist as a potential route for the spread. The findings of nonadenoma on dedicated adrenal CT as well as high uptake on 18F-FDG PET/CT can be also seen, as previously reported. The awareness of these radiologic features of adrenal tuberculosis may enable to perform additional laboratory tests or image-guided biopsy for assessing tuberculous infection,

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