PMC3863964_01
Baseline axial contrast-enhanced CT (CECT) (a) demonstrates normal adrenal glands and kidneys (open white arrow and asterisk). Three-month follow-up axial (b) and coronal (c) CECT after the patient received external beam RT for L2 thecal metastasis (not shown) reveals decreased and delayed nephrogram in the medial upper pole of both kidneys (asterisk) in keeping with radiation nephropathy. The patient also developed bilateral, symmetric low density thickening of the adrenal glands (open white arrows in b and c) without nodularity. The findings were thought to be on the basis of radiation-induced adrenal injury. Magnified view (d) of follow axial CT image (b) illustrates preserved cortical enhancement (thin white arrow) with low density symmetric thickening of the adrenal medulla (M).
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The adrenal glands and kidneys were normal at the first presentation (Fig. 1). At time of repeat imaging, the kidneys demonstrated bilateral medial upper pole decreased density (delayed nephrogram) in keeping with acute radiation-induced renal injury or radiation nephropathy (Fig. 1). A thin rim of preserved cortical enhancement was distinctly preserved (Fig. 1.)
Initial follow-up axial and coronal CECT (a) images performed after RT demonstrate radiation-induced renal (white asterisk) and presumed adrenal (white arrows) injury. Repeat axial and coronal CECT (b) images performed 2 months later depict worsening radiation nephropathy (black asterisk) and progression of radiation-induced adrenal injury (black arrows).
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A third follow-up CECT was performed in March 2012 which showed imaging findings consistent with progression of both radiation nephropathy (Fig. 2) and radiation-induced adrenal injury (Figs. 2 and 3).
Baseline (a), initial post RT follow-up (b), and final follow-up (c) axial CECT images demonstrate progressive findings of radiation induced adrenal injury. After initial RT (b) there is development of diffuse, symmetric, bilateral low density thickening of the adrenal glands without nodularity. Note preservation of thin enhancing adrenal cortex in (b) (white arrows) with retroperitoneal stranding (S). Final CECT follow-up (c) demonstrates progression of findings with loss of normal enhancing adrenal cortex (black arrows) associated with biochemical findings of adrenal cortical insufficiency.
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At this time, preserved adrenal cortical enhancement was no longer apparent (Fig. 3).