Hello! A lesion was observed in the right adrenal gland location during the scan of an 8 y/o golden retriever mix that presented with acute vomiting and hepatopathy. The liver, gallbladder, CBD, etc appeared normal. GI tract appeared normal. However, when scanning for the right adrenal gland I identified this structure. I spent time looking for a normal R adrenal and could not identify one. The left appeared normal and the LAG caudal pole measured 0.55 cm in diameter.
Hello! A lesion was observed in the right adrenal gland location during the scan of an 8 y/o golden retriever mix that presented with acute vomiting and hepatopathy. The liver, gallbladder, CBD, etc appeared normal. GI tract appeared normal. However, when scanning for the right adrenal gland I identified this structure. I spent time looking for a normal R adrenal and could not identify one. The left appeared normal and the LAG caudal pole measured 0.55 cm in diameter.
I’m just not convinced it’s the R adrenal gland. A normal phrenic wasn’t readily apparant to help identify and it seemed more ventral than I anticipated for the R adrenal.
Any thoughts are appreciated. Thanks!
Comments
Hi! I see what you mean with
Hi! I see what you mean with the confusion in identifying this abnormality. I agree that the location of the structure is not exactly where the RAD would typically be. I think its in the area of the RAD, craniomedial to the RK and near the CVC, and I think I see the celiac artery next to the structure come in and out of the picture in the first clip. I cannot obviously identify the renal artery and vein.
There’s not really any other structures that generally live in this area so I would have a high suspicion that this is the RAD unless the RAD can be definitively visualized and differentiated from this structure. There may be some mild anatomical variation of the RAD in this patient.
If it is confirmed to be the RAD, primary DDx may include functional or nonfunctional adenoma, pheo, or other neoplasia. I dont see any parenchyma mineralization which is good and, although there is asymmetrical capsule expansion, the capsule appears to be intact.
If the RAD can be definitively visualized, the primary DDx in my opinion would be a reactive mesenteric LN possibly secondary to GI inflammation with vomiting as it is also adjacent to the SI in the third clip .
Thanks, Mac!
Thanks, Mac!
I would be concerned for
I would be concerned for distorted LN here. In your last clip the RAD should come in at 6 oclock whereas this structure noted is more in the area of hepatic LN or even pancreas. If you take another sweep of the RK to the RAD posiiton 14 SDEP and pin the RK against the body wall first, keep the pressure on when dropping th eprobe tail straight down and not at an angle. The poles of the RK should dissappear at the same time and the RAD will come into view at 3-4 cm if you have a long CVC across the screen.
Here is our educational series on Adrenal approiach which should help.
See “No Adrenal Left Behind” series here in resources
https://sonopath.com/resources/instructional-library-interventional-procedures-sonopodcasts