Retroperitoneum

CHAPTER 12

Retroperitoneum

Physiology

Adrenal glands (fig. 12-1)

Technique

Preparation

Examination technique and image optimization

• Use the highest-frequency abdominal transducer possible to obtain optimal resolution for penetration depth.

• Place gain settings to display the normal liver parenchyma as a medium shade of gray with adjustments to reduce echoes within the vessels.

• Focal zone(s) at or below the place of interest.

• Sufficient imaging depth to visualize structures immediately posterior to the region of interest.

• Harmonic imaging or decreasing system compression (dynamic range) can be used to reduce artifactual echoes within anechoic structures.

• Spatial compounding can be used to improve visualization of structures posterior to a highly attenuating structure.

• Supine, oblique, and/or decubitus positions may be used.

• Sagittal or coronal and transverse planes are used to evaluate and document the adrenal glands using surrounding anatomical landmarks.

• Documentation and measurement of the length, height, and width.

• Color Doppler imaging, using a 60-degree angle or less, to evaluate each adrenal gland visualized.

• Evaluation and documentation of the retroperitoneum using a four- or nine-quadrant method.

• Length, height, and width of visible lymph nodes, including color Doppler imaging of the hilum.

• Documentation and measurement of any abnormality in two scanning planes with and without color Doppler should be included.

Laboratory values

Adrenocorticotrophic hormone (ACTH)

Sodium

Benign Adrenal Pathology

PATHOLOGY ETIOLOGY CLINICAL FINDINGS SONOGRAPHIC FINDINGS DIFFERENTIAL CONSIDERATIONS
Adenoma Benign cortical massFunctioning or nonfunctioningRisk Factors: Diabetes mellitus Obesity Hypertension Older population AsymptomaticElevated adrenal hormones Hypoechoic, homogeneous massSmooth wall marginsMay demonstrate necrosis or hemorrhage Adrenal hyperplasiaAdrenocortical carcinomaRenal or liver massAdrenal hemorrhage
Adrenal cyst RareUnilateral AsymptomaticHypertension Anechoic massWell-defined wall marginsPosterior acoustic enhancementWalls may calcify Cyst of the liver, spleen, or kidneyHydronephrosis
Adrenal hemorrhage Adrenal massHypoxiaTraumatic deliverySepticemia AsymptomaticPalpable abdominal massDecrease in hematocrit Cystic or complex adrenal massFrequently located on the right Cyst or neoplasm of the liver, spleen, or kidneyAdenomaAdrenocortical carcinoma
Adrenal hyperplasia Proliferation in adrenal cellsTypically bilateral AsymptomaticHypertensionElevated adrenocorticotrophic hormone (ACTH) level Enlargement of the adrenal gland(s)Change in the normal triangular shape AdenomaAdrenocortical carcinoma
Pheochromocytoma Rare vascular tumor of the medullaSmall percentage are malignantRight-side prevalence HypertensionSweatingTachycardiaChest or epigastric painHeadachePalpitationsSevere anxietyIncrease in epinephrine and norepinephrine Solid massHomogeneous textureMay appear complex because of necrosis or hemorrhageMay calcifyMetastasis to liver, lymph nodes, lung, and bone if malignant Renal massAdrenocortical carcinomaAdrenal adenomaAdrenal hemorrhage

image

Conditions Associated with the Adrenal Glands

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Jun 15, 2016 | Posted by in GYNECOLOGY | Comments Off on Retroperitoneum

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CONDITION DESCRIPTION ETIOLOGY CLINICAL FINDINGS
Addison disease Life-threatening condition caused by partial or complete failure of adrenocortical function (hypofunction)Destruction of the adrenal cortexLoss of cortisol and aldosterone secretionsIncreased incidence in femalesDiagnosis is established if the amount of cortisol in the plasma and steroid in the urine do not increase after stimulation with adrenocorticotrophic hormone (ACTH)