M. Paetzel (Leipzig)  

Viewable for logged on visitors (Log on)  

7 Years  

Female  

Abdomen-Adrenals  

circulatory  

7 year-old, developmentally normal girl. In the course of a pulmonary infection, an x-ray was ordered to rule out a pneumonia. A pathologic finding in the lung was not seen on the x-ray, but as an incidental finding, there was a round, calcified structure in the right upper abdominal quadrant seen.

The patient's history is unremarkable.  

The pathogenesis of such a dense round calcification is first and foremost due to a perinatally acquired adrenal hemorrhage with subsequent calcification in the area of the capsule.

However, in the majority the post-hemorrhagic adrenal calcifications are rather irregularly shaped and not so homogenically dense seen on plain films as seen in this case.

Calcifications in a neoplastic setting (neuroblastoma!) are also more diffuse and irregular shaped.  

<- view X-Ray 1

X-ray 1: round, ca 1,5 cm large, calcified opacity in the right paravertebral area at the level of the 12th thoracic vertebra.




<- view X-Ray 2

X-ray 2: round, ca 1,5 cm large, calcified opacity projecting over the intervertebral space between the 11th and 12th thoracic vertebral bodies.




<- view MRI 1

MRI 1: T1-FLASH 2D-Gradient echo sequence (dynamic series, before gadolinium administration): Signal free mass posterior to the inferior vena cava. The adrenal gland cannot be definitely separated.




<- view MRI 2

MRI 2: T1-FLASH 2D-Gradient echo sequence (dynamic series, arterial phase after gadolinium administration): Signal free mass posterior to the inferior vena cava.




<- view MRI 3

MRI 3: T1-FLASH 2D-Gradient echo sequence (dynamic series, venous phase after gadolinium administration): Signal free mass posterior to the inferior vena cava.




<- view MRI 4

MRI 4: T1-FLASH 2D-Gradient echo sequence out of phase: No signal change compared to in phase images.




<- view MRI 5

MRI 5: T2-TIRMm transversal: Within the low signal lesion there is an area of slightly increased signal intensity, consistent with central located fluid.




<- view MRI 6

MRI 6: T2-HASTE (breathhold) axial: Within the low signal lesion there is an area of slightly increased signal intensity, consistent with central located fluid.


 

Expert's opinion  

Neuroblastoma, calcified lymph node in tuberculosis  

Incidental finding, no hormonal deficits.  

The diagnosis was already made after the x-ray. The ultrasound image (not shown here) showed concordantly an acoustic shadow in the adrenal location superior to the kidney.

Even though from a pediatric radiological standpoint there were no further examinations needed, the parents insisted on magnetic resonance imaging. In the rare case that such a lesion is worked up by MR imaging, it allows the knowledge that the center of the calcified adrenal hemorrhage still showed liquid components. In the gradient echo sequences however, the fluid components are not seen due to susceptibility artifacts.

Even after a two-year clinical observation, there were no other causes seen for the suprarenal calcification (no tumorous growth).  

N/A  

1. Medline:
Paterson A.
Adrenal pathology in childhood: a spectrum of disease.
Eur Radiol. 2002 Oct;12(10):2491-508.  

Adrenal hemorrhage, Suprarenal hemorrhage, calcification, suprarenal gland, neuroblastoma, suprarenal calcification, adrenal calcification, adrenal gland, adrenals, child, childhood, pediatric radiology  

M Paetzel. Adrenal calcification after adrenal hemorrhage. PedRad [serial online] vol 3, no. 12.
URL: www.PedRad.info/?search=20031228224217