PMC5894017_01
Abdominal, contrast-enhanced CT scan: a solid (18 mm) left adrenal mass with regular margins is detected.
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The lesion was hypervascular with sharp and regular edges (Figure 1).
T1, chemical-shift in-phase (A) and out-of-phase (B): a round, left adrenal mass without signal intensity loss is showed.
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The chemical-shift sequence (CS) showed no significant reduction in signal intensity with a CS index of 0.7% (Figure 2A, 2B).
T2, TSE, SPAIR image showing the hyperintense nodular lesion.
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On T2, TSE and SPAIR images, the mass was hyperintense (Figure 3); the dynamic post-contrast MRI sequence showed a comparable result to CT.
PET-CT with FDG shows a faint linear tracer uptake (SUV max 3.1) in the left adrenal space without focal morphology.
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For this reason, the patient underwent PET-CT with FDG which showed a slight and unclear tracer uptake (SUV max 3.1) in the left adrenal space (Figure 4), with fusiform morphology that did not perfectly match the nodule but was probably characteristic of a normal adrenal gland.
Adrenal scintigraphy with I123-MIBG (anterior view) shows a focal tracer uptake in the left adrenal bed where the nodular mass was detected.
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Due to the suspicion of a "silent" pheochromocytoma, medullary adrenal scintigraphy with I123-MIBG was performed on which intense, focal, tracer uptake in the left adrenal nodule was found (Figure 5).