Imaging Pearls ❯ Adrenal ❯ Adrenal Infection
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- “Peripheral lobar calcifications represent another pattern that delineates end-stage kidney disease and are characteristic of TB. With this pattern, lobar calcific rims usually outline the periphery of distorted renal lobes as a sequela of papillary necrosis. A focal globular pattern of calcifi-cation of the entire renal lobe, when seen, is often a sequela of a granulomatous mass. Lobar calcification, in which a densely calcified rim out-lines the periphery of the distorted renal lobes, is considered to be characteristic of renal TB.”
Imaging Manifestations of Genitourinary Tuberculosis
Muhammad Naeem et al.
RadioGraphics 2021;41:1123–1143 - “Renal TB has a propensity to extend into the psoas sheath, perirenal and pararenal spaces (resulting in cold abscesses), sinus tracts, and fistulas and can also be seen in conjunction with tuberculous spondylitis (Pott disease). Extension to other viscera in the abdo-men also has been described, with kidney-to–ali-mentary tract fistulas being the most common. Other fistulous communications to the skin, solid viscera, and bronchi also may be seen .”
Imaging Manifestations of Genitourinary Tuberculosis
Muhammad Naeem et al.
RadioGraphics 2021;41:1123–1143 - “TB commonly has long-segment involvement of the ureter, often with periureteric fat strand-ing during the early phase of infection. Transitional cell cancer usually manifests as focal, often asymmetric wall thickening of the ureter without fat stranding. Calcifications can manifest with TB and need to be differentiated from schistosomiasis. With TB, the calcifications are contiguous with the renal collecting system, whereas with schistosomiasis, they are more focal and more common in the urinary bladder. Also, ureteral calcifications in TB are intraluminal and appear as a cast of the ureter, whereas with schistosomiasis, calcifications are intramural.”
Imaging Manifestations of Genitourinary Tuberculosis
Muhammad Naeem et al.
RadioGraphics 2021;41:1123–1143
- "Adrenal infections are rare but important causes of adrenal insufficiency. These infections are the leading cause of adrenal insufficiency in the developing world, where they are more prevalent. They are more common in immunocompromised subjects, and infections may be primary or secondary to systemic infections. Mycobacterium tuberculosis accounts for 30% of the reported cases. Histoplasma capsulatum, Nocardia asteroides, Aspergillus species, Cryptococcus neoformans, Pneumocystis jirovecii, and cytomegalovirus are among the other causes of adrenal infection.”
Cross‐sectional imaging features of unusual adrenal lesions: a radiopathological correlation
Karaosmanoglu AD et al.
Abdominal Radiology (2021) 46:3974–3994
- "Hematogenous spread of the Mycobacterium tuberculosis is the most common route for adrenal tuberculosis. The disease’s course may be highly insidious, and it may take years for the symptoms to become apparent and asymptomatic disease is also not uncommon. In patients with active tuberculosis, around 9% have signs of involvement in autopsy studies, and for the adrenal insufficiency to develop, approxi- mately more than 90% of the gland must be destroyed.”
Cross‐sectional imaging features of unusual adrenal lesions: a radiopathological correlation
Ali Devrim Karaosmanoglu et al.
Abdominal Radiology (2021) 46:3974–3994
- “Adrenal infections, although rare are important causes of adrenal insufficiency. Infection is the leading cause of adrenal insufficiency (Addison’s disease) in the developing world, with the most common agent Mycobacterium tuberculosis accounting for approximately 30% of reported cases. As with infections elsewhere in the body, adrenal infections are more common in the immunocompromised patient . Adrenal infections can be primary or secondary to systemic dissemination and adrenal involvement in systemic infection is reported in up to 80 percent of cases evaluated with autopsy.”
CT and MR imaging of acute adrenal disorders
Amar Udare et al.
Abdominal Radiology (2021) 46:290–302 - “Early tuberculous adrenalitis is seen as bilateral adrenal enlargement with central non-enhancing areas due to necrosis with peripheral enhancement. The imaging appearance of Histoplasmosis is indistinguishable from that of Tuberculosis and should be considered in the differential diagnosis in endemic areas, as adrenal insufficiency is seen in up to 50% of patients with disseminated histoplasmosis and is fatal if untreated. In chronic stages both tuberculosis and histoplasmosis are seen as atrophic adrenal glands with foci of calcification.”
CT and MR imaging of acute adrenal disorders
Amar Udare et al.
Abdominal Radiology (2021) 46:290–302
- "Adrenal infections, although rare are important causes of adrenal insufficiency. Infection is the leading cause of adrenal insufficiency (Addison’s disease) in the developing world, with the most common agent Mycobacterium tuberculosis accounting for approximately 30% of reported cases . As with infections elsewhere in the body, adrenal infections are more common in the immunocompromised patient. Adrenal infections can be primary or secondary to systemic dissemination and adrenal involvement in systemic infection is reported in up to 80 percent of cases evaluated with autopsy.”
CT and MR imaging of acute adrenal disorders
Amar Udare et al.
Abdominal Radiology https://doi.org/10.1007/s00261-020-02580-w - "Early tuberculous adrenalitis is seen as bilateral adrenal enlargement with central non-enhancing areas due to necrosis with peripheral enhancement. The imaging appearance of Histoplasmosis is indistinguishable from that of Tuberculosis and should be considered in the differential diagnosis in endemic areas, as adrenal insufficiency is seen in up to 50% of patients with disseminated histoplasmosis and is fatal if untreated. In chronic stages both tuberculosis and histoplasmosis are seen as atrophic adrenal glands with foci of calcification.”
CT and MR imaging of acute adrenal disorders
Amar Udare et al.
Abdominal Radiology https://doi.org/10.1007/s00261-020-02580-w