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Abdomen » Retroperitoneum
Adrenal metastasis
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Presentation A 60 year old man presents with hemoptysis and pleural effusion on chest X-ray.
Caption: Sagittal view of the right upper quadrant
Description: A solid appearing, well-defined mass is seen in the right suprarenal region. The visualized liver and IVC appear normal.
Caption: Transverse view of the right upper quadrant
Description: The well-defined, heterogeneous mass is noted again. It indents the IVC, but does not invade it.
Differential Diagnosis This is a solid adrenal mass which could be due to cortical adenoma, metastasis, carcinoma, pheochromocytoma or ganglioneuroma
Final Diagnosis This is a metastatic solid adrenal mass. The patient had a malignant lung mass with pleural effusion
Discussion Silent adrenal metastases occur frequently in lung cancers and are often detected on cross-sectional imaging studies. Enlarged adrenal glands can be visualized on ultrasound and appear as solid and heterogeneous lesions, predominantly hypoechoic. Not all enlarged adrenal glands are metastatic and therefore ultrasound guided needle biopsy may be required to confirm the diagnosis in many cases.

Thus in any patient with a lung cancer, the adrenal glands must be imaged to rule out secondary involvement.
Case References 1. Kocijancic K, Kocijancic I, Guna F. Role of sonographically guided fine-needle aspiration biopsy of adrenal masses in patients with lung cancer.  J Clin Ultrasound. 2004 Jan; 32(1):12-6.
2. Filon E, Kodur E, Cygan M. Ultrasonographic examination of the adrenal glands for detection of lung cancer metastasis. Nowotwory. 1989 Jul-Dec; 39(3-4):157-61.
3.  Kocijancic I, Vidmar K, Zwitter M, Snoj M. The significance of adrenal metastases from lung carcinoma. Eur J Surg Oncol. 2003 Feb; 29(1):87-8.
4. Gervais Wansaicheong and Jeffrey Goh. Adrenal metastases.
Follow Up This patient had a metastatic adrenal lesion.
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