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Imaging of Medical and Surgical Adrenal Lesions

  • Chapter
Radiology of the Upper Urinary Tract

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

The function of the adrenals has long been obscure and it was not until the twentieth century that the endocrine activity of the gland was fully understood. Originally, the Roman anatomist Bartholomaeus Eustachius discovered the gland and described it in his Libellus de renibus in 1563. Thomas Bartholin (1616–1680), misunderstanding the function of the gland, described the adrenals as “capsules of the black bile” (Fig. 1.1) in accordance with Vesalius’ concept of the human body fluids, and even in the classic texbook by Joseph Hyrtl (1887) the adrenal gland was referred to as “capsulae atrabiliariae” or “capsulae Bartholini.” Following the discovery of epinephrine by the end of the nineteenth century, the function of the adrenals was gradually unveiled. Morphologic in vivo diagnostics started with abdominal plain roentgenogram, urography, and nephrotomography, which were later supplemented by retroperitoneal pneumography, adrenal arteriography, and phlebography. Since the advent of the new imaging modalities such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and radioisotope studies, direct visualization of the adrenals has considerably improved. CT, MRI, and ultrasound are currently the most important modalities for adrenal imaging, permitting visualization of the normal adrenal glands and tumors larger than 5 mm in diameter. However, due to the small thickness of the gland, differentiation of adrenal cortex and medulla in the adult is not feasible; also, atrophy and hyperplasia may be difficult to diagnose because of the wide range of normal adrenal size. Density measurement, signal intensity, echogenicity, and contrast behavior permit classification of adrenal tumors to a limited degree. In addition to the various morphologic modalities, functional studies, such as radioisotope scanning and selective venous sampling, are also available, and are supplemented by percutaneous biopsy.

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  1. Department of Diagnostic Radiology, Medical School, RWTH Aachen, University of Technology, Pauwelsstraße 30, W-5100, Aachen, Germany

    Rolf W. Günther M.D. & Christoph Müller-Leisse M.D.

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  1. Rolf W. Günther M.D.
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  2. Christoph Müller-Leisse M.D.
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  1. Department of Radiology, School of Medicine, Medical Center, Louisiana State University, 1542 Tulane Avenue, New Orleans, LA, 70122-2822, USA

    Erich K. Lang M. D. (Professor and Chairman) (Professor and Chairman)

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Günther, R.W., Müller-Leisse, C. (1991). Imaging of Medical and Surgical Adrenal Lesions. In: Lang, E.K. (eds) Radiology of the Upper Urinary Tract. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84189-7_1

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