Abdo stuff

Question 1

how common are incidental adrenal masses

Answer 1

3% - 7%

Question 2

What is the most common type of adrenal incidental finding?

Answer 2

benign nonhyperfunctionoing adenoma

Question 3

What do you make of an adrenal mass in a patient with a known malignancy?

Answer 3

Even though they have a cancer the incidental finding is most likely going to be a benign adenoma

Question 4

types of adrenal primary?

Answer 4

pheao
aldosteronomas
adrenal cortical carcinomas

Question 5

what are the types of ‘leave alone’ adrenal masses

Answer 5

nonhyperfunctioning
myelolipoma
haemorrhage
cyst

Question 6

mass requring intervention for incidental finding of adrenal

Answer 6

mets
adrenal cortical carcinoma
hyperfuncitoning adrenal tumour

Question 7

what are incidental adrenal mass size criteria for considering

Answer 7

if over 1cm then need to consider the algorithm

Question 8

What are diagnostic benign imaging features of the adrenal masses >1cm

Answer 8

Calcium, myeloplipoma, no enhancement then benign .

less than 10 hounsfields or low signal on CS-MR - benign adenoma

Question 9

If the adrenal mass features are not benign - what are they called?

Answer 9

indeterminate

Question 10

what are the size cut offs for indeterminate adrenal masses

Answer 10

1- 4cm

or greater than 4cm

Question 11

if adrenal indeterminate mass is greater than 4cm what do you do?

Answer 11

if no history of cancer then resection

if preivous cancer then biopsy or PET-CT.

Question 12

If adrenal mass has indeterminate features and measures between 1cm and 4cm what do you consider?

Answer 12

whether there is prior imaging.

• is it stable for great than 1 year –> no f/u required
• if it is confirmed NEW or enlarging then same as before re cancer history or doing PET CT

if no prior imaging

• 1-2cm - 12 month adrenal CT scan
• 2-4cm or cancer Hx - do an adrenal CT.

After adrenal CT

• NCCT less than 10 HU - benign adenoma
• > 10 HU need to do a CT washout

then work out the APW / RPW

Question 13

what features should you report upon for an adrenal mass?

Answer 13

macroscopic fat
CT density (HU)
MR signal drop (in phase / opposed phase)
size
timeframe
cancer diagnois 
biochemical abnormalities

Question 14

What are adrenal mass diagnostic benign imaging features?

Answer 14

myelolipoma - macroscopic fart
cyst
haemorrhage (masses without enhancement)

Question 15

How do adrenal adenomas enahnce on CT adrenal

Answer 15

enhance rapidly but also washout quickly

Question 16

How do adrenal masses that are mets enhance and washout

Answer 16

enhance quickly but washout slowly

Question 17

if an adrenal mass shows avid enhancement what do you consider and order?

Answer 17

pheo and need serum catecholamines need to be tested

Question 18

which is better for adrenal lesions CT or CS-MRI

Answer 18

CT