Adrenal Mass
Paula J. Woodward, MD
DIFFERENTIAL DIAGNOSIS
Common
Bronchopulmonary Sequestration (Mimic)
Neuroblastoma
Rare but Important
Adrenal Hemorrhage
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Search carefully for an adrenal gland
Neuroblastoma and hemorrhage involve the adrenal gland, while a sequestration is separate from it
Normal adrenal gland has an “ice cream sandwich” appearance
Hypoechoic cortex, hyperechoic medulla
Helpful Clues for Common Diagnoses
Bronchopulmonary Sequestration (Mimic)
10-15% subdiaphragmatic
Majority left-sided
Stomach is displaced anteriorly
Typically an echogenic, solid mass
May see small cystic areas
Separate from adrenal gland
Color Doppler important for diagnosis
Look for dominant feeding vessel from aorta
Usually presents in 2nd trimester
Neuroblastoma
May be either cystic or solid
Approximately equal occurrence
60% are right-sided
No identifiable adrenal gland on side of mass
Displaces kidney inferiorly
Color Doppler may show diffuse vascularity but no dominant feeding vessel
Usually presents in 3rd trimester
Solid masses are more likely to metastasize
Liver most common site for metastases in utero
Hydrops may develop with large masses or metastatic disease
Cystic masses are usually complex, with thick septations
Helpful Clues for Rare Diagnoses
Adrenal Hemorrhage
Reported in utero but uncommon
Can be solid or cystic
Appearance variable and changes with evolution of blood products
Will involute over time
No color flow within mass
MR can confirm blood products
Other Essential Information
Neuroblastoma has variable, but generally favorable, in utero course
> 90% overall survival
Tumors remain stable or even spontaneously resolve
Cystic masses have best prognosis and may represent involuting tumor
Minority of cases progress to hydrops and even death
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