Case Study

Bilateral adrenal gland masses with phrenic vein invasion in a 12 year old FS Bichon Frise

This 12 year old FS Bichon Frise presented with diarrhea/hematochezia, abdominal pain. Elevated hepatic enzymes.

DX

Bilateral adrenal gland masses. Right adrenal mass appears to invade the phrenic vein, which would define it as a pheochromocytoma or adenocarcinoma.

Image Interpretation

The left kidney measured 4.86 cm with thickened cortices with patchy, mixed, echogenic micro infarctions. The left adrenal gland comprised a mixed, echogenic mass that measured 3.92 x 3.49 cm with complete disruption of architecture with hyperechoic nodules. The right adrenal gland was enlarged, irregular and nodular measuring 3.46 x 1.24 cm at the cranial pole and 1.66 cm at the caudal pole. The right adrenal mass invades into the phrenic vein. The right adrenal gland did appear to be significant vascular.

Outcome

Differentials for the left adrenal mass includes myelolipoma, pheochromocytoma or
adenocarcinoma. Right adrenal mass is either pheochromocytoma or adenocarcinoma
given the phrenic vein invasion. 25-gauge FNA could be considered. I am more
concerned about the right adrenal mass from a functional standpoint as opposed to the
left adrenal mass, which does not appear to be invasive even if it is the larger of the
two. Serial blood pressure measurements and full adrenal gland panel from the
University of Tennessee would be indicated. Endoscopy would be indicated