{"id":48088,"date":"2022-11-02T11:02:52","date_gmt":"2022-11-02T11:02:52","guid":{"rendered":"https:\/\/www.imv-imaging.com\/2022\/11\/ultrasonography-of-the-adrenal-glands\/"},"modified":"2025-01-31T12:55:12","modified_gmt":"2025-01-31T12:55:12","slug":"news-ultrasonography-of-the-adrenal-glands","status":"publish","type":"post","link":"https:\/\/www.imv-imaging.com\/en\/2022\/11\/news-ultrasonography-of-the-adrenal-glands\/","title":{"rendered":"Ultrasonography of the Adrenal Glands"},"content":{"rendered":"\n<p><span data-contrast=\"auto\">The improved resolution of newer ultrasound systems has allowed visualisation of the adrenal glands with more regularity. <\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Specific indications for ultrasonography of the adrenal glands include:\u00a0<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><span data-contrast=\"auto\">The presence of a mass or masses in the dorsal abdomen<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Investigation for metastatic spread of neoplasia<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Differentiating between adrenal and pituitary dependant hyperadrenocorticism<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Investigation of hypertension and symptoms suggestive of phaeochromocytoma<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Normal Anatomy&nbsp;<\/span><\/h3>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/Adrenal%20Glands%201.png\" alt=\"Adrenal Glands 1\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\"><\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">The adrenal glands are paired organs situated within the retroperitoneal space. Each adrenal gland is located craniomedially to their respective kidney.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><i><span data-contrast=\"auto\">An illustration of the adrenal gland position and surrounding anatomy in the dog.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">The right adrenal gland is situated in close apposition to the vena cava, whilst the left adrenal gland is more commonly separated from the aorta by a pad of fatty tissue. The size and shape of each adrenal gland varies with body weight, age, and conformation.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Generally, the left adrenal gland has a narrower central section with a wider cranial and caudal pole. This gives the left adrenal gland a \u201cpeanut\u201d shape. In comparison, the right adrenal has a \u201ccomma\u201d or \u201carrowhead\u201d shape.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">The phrenicoabdominal artery passes dorsally to each adrenal gland and the phrenicoabdominal vein passes ventrally.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">In cats, the adrenal glands have a uniform oval shape. Incidental mineralisation is a normal finding seen in older cats<\/span><span data-contrast=\"auto\">1<\/span><span data-contrast=\"auto\">.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Examination Technique&nbsp;<\/span><\/h3>\n\n\n\n<p><span data-contrast=\"auto\">Ultrasonographic visualisation of both adrenal glands can be difficult, especially in large, deep-chested, or obese patients.&nbsp;<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Due to the cranial and dorsal location of the adrenal glands, it is important to ensure that the patient is adequately clipped. Extend the clipped area to the edge of the lumbar musculature dorsally and, in deep-chested or large breed patients, include the caudal 2-3 intercostal spaces in the clipped area because it can be necessary to use an intercostal window to visualise the adrenal glands.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Assessment of the adrenal glands can take time and may involve pressure on some areas of the dorsal abdomen. Therefore, sedation can be useful to improve patient comfort and facilitate the ultrasound examination.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">The highest frequency setting that gives adequate depth of penetration to view the area of the adrenals should be used. In most patients, a frequency of 5 \u2013 7.5 MHz is adequate. However, higher frequencies (8 \u201315 MHz) will improve image resolution and can be utilised in smaller patients. Either a micro-convex or linear transducer can be used for the examination. Linear transducers are capable of higher frequency settings and are ideal for smaller patients. However, their larger footprint makes them harder to manoeuvre around the body. In comparison, micro-convex transducers produce a lower frequency range though their smaller, curved surface make them ideal in larger patients and for imaging using the intercostal spaces.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><strong><span data-contrast=\"auto\">Due to the small size of the normal adrenals, the use of anatomic landmarks to guide an examination of the adrenal glands is essential.<\/span><\/strong><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">The left adrenal gland is examined with the patient in right lateral recumbency; the patient is positioned in left lateral recumbency to examine the right adrenal gland.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/IMAGE%202%20Left%20adrenal%20position.jpg\" alt=\"IMAGE 2 Left adrenal position\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\"><\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span data-contrast=\"auto\">Left Adrenal Gland<\/span><\/strong><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/h4>\n\n\n\n<p><span data-contrast=\"auto\">With the transducer marker orientated cranially, identify the left kidney. A dorsal imaging plane can be useful to avoid interference from neighbouring gas-filled intestinal structures. From the left kidney the transducer can be fanned towards the midline to identify the aorta. Small motions should then be used to achieve a longitudinal plane image of the aorta at this level.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">With small fanning motions dorsally or ventrally, the renal artery should be identifiable branching from the aorta and turning (\u201chooking\u201d) cranially towards the hilar area of the left kidney.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">The left adrenal gland is situated cranial to the \u2018hook\u2019 of the renal artery between the cranial pole of the left kidney and aorta. Small fanning motions and\/or slight rotation of the transducer at this level may be needed to achieve a longitudinal image of the left adrenal gland, revealing the typical \u201cpeanut\u201d shape.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Once identified, the transducer can be rotated through 90\u00b0 to achieve a transverse plane image of the adrenal.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/IMAGE%203%20Right%20adrenal%20position.jpg\" alt=\"IMAGE 3 Right adrenal position\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span data-contrast=\"auto\">Right Adrenal Gland<\/span><\/strong><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/h4>\n\n\n\n<p><span data-contrast=\"auto\">With the transducer marker orientated cranially, identify the right kidney, and orientate the transducer to view the right kidney in a dorsal plane.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">By fanning the transducer towards the patient\u2019s midline or sliding the transducer ventrally the caudal vena cava can be identified in a longitudinal orientation. It is important not to press too hard as this will compress the vena cava and make it harder to visualise.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">The right adrenal gland lies dorso-medial to the caudal vena cava. By fanning the transducer between the caudal vena cava and the cranial pole of the right kidney, the right adrenal is visible at the point the vena cava just disappears from view. In a longitudinal plane, the right adrenal has a more triangular\/ \u201carrow-head\u201d shape compared to the left.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Once identified, the transducer can be rotated through 90\u00b0 to achieve a transverse plane image of the right adrenal gland. In this plane the adrenal gland will appear oval in shape.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Due to the more cranial position of the right adrenal gland, in larger patients it may be necessary to use an intercostal approach via the last 2 rib spaces to view the right adrenal gland.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Normal appearance&nbsp;<\/span><\/h3>\n\n\n\n<p><span data-contrast=\"auto\">The adrenal glands usually appear uniformly hypoechoic. When using higher frequency ranges, a change in echogenicity between the outer cortex and inner medulla may be visualised in some patients.\u00a0\u00a0<\/span><br><\/p>\n\n\n\n<p><span data-contrast=\"auto\">As the adrenals have a hypoechoic appearance, it can be difficult to identify the glands from adjacent vascular structures. <a href=\"https:\/\/www.imv-imaging.com\/en\/2023\/05\/news-why-should-i-care-about-doppler\/\">Colour flow Doppler<\/a> ultrasound modes can be used to help resolve the adrenal from the surrounding blood vessels.\u00a0<\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/IMAGE%204%20Left%20Adrenal%20Images.jpg\" alt=\"IMAGE 4 Left Adrenal Images\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\"><\/span><\/p>\n\n\n\n<p><strong><i><span data-contrast=\"auto\">Examples of the appearance of the left adrenal gland in dogs. <\/span><\/i><\/strong><i><span data-contrast=\"auto\">Image A) The left adrenal gland (red arrow, cranial pole; callipers, caudal pole) can be seen in a longitudinal plane adjacent to the cranial pole of the left kidney. Part of the aorta can be seen (green arrow). Image B) The typical \u201cpeanut\u201d shape of the left adrenal gland can be seen (blue arrow, cranial pole; callipers, caudal pole). The adrenal gland is situated cranial to the \u2019hook\u2019 of the left renal artery (yellow arrow).<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/IMAGE%205%20Feline%20Adrenal.jpg\" alt=\"IMAGE 5 Feline Adrenal\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><strong><i><span data-contrast=\"auto\">Feline Left Adrenal Gland<\/span><\/i><\/strong><i><span data-contrast=\"auto\">. This image shows the normal feline left adrenal gland (red arrow). In comparison to dogs, the adrenal gland is smaller and more oval shaped.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/IMAGE%206%20Right%20Adrenal.jpg\" alt=\"IMAGE 6 Right Adrenal\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><strong><i><span data-contrast=\"auto\">Right adrenal gland in the dog. <\/span><\/i><\/strong><i><span data-contrast=\"auto\">This image shows a sagittal plane image of the right adrenal gland (red arrow and callipers). Note the triangular or \u201carrowhead\u201d shape.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">There are published reference ranges for normal adrenal gland size (below). However, adrenal gland size varies among individual patients and there is an overlap in size range between normal dogs and those with adrenal or endocrine abnormalities. To measure the adrenal gland thickness, a sagittal or dorsal plane image of the adrenal is acquired, and the width of the caudal pole is measured.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">\u22640.54cm (Dogs &lt;10kg)<\/span><span data-contrast=\"auto\">2<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">&nbsp;\u22640.68cm (Dogs 10-30kg)<\/span><span data-contrast=\"auto\">2<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">&nbsp;\u22640.8cm (Dogs &gt; 30kg)<\/span><span data-contrast=\"auto\">2<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">In cats, the short axis diameter of the adrenal gland can be measured as the dorsoventral width of the adrenal in a sagittal or dorsal plane image.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Cat: Short axis diameter of the adrenal = 1.5mm-5.9mm<\/span><span data-contrast=\"auto\">3<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">Ultrasonographic appearance of adrenal pathology<\/span><\/h3>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span data-contrast=\"auto\">Adrenal Gland Hyperplasia<\/span><\/strong><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/h4>\n\n\n\n<p><span data-contrast=\"auto\">Bilateral enlargement of the adrenal glands can be seen in patients with pituitary dependant hyperadrenocorticism (PDH). This can appear as symmetrical enlargement and rounding of the adrenal glands. However, unilateral enlargement, bilateral unequal enlargement and adrenal masses or nodules are occasionally reported in cases of PDH<\/span><span data-contrast=\"auto\">4<\/span><span data-contrast=\"auto\">. Therefore, it is not always possible to differentiate PDH from adrenal neoplasia. Non-hormonal disease can also cause adrenal enlargement and ultrasound findings should always be interpreted alongside patient history, clinical exam, and laboratory test results.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/IMAGE%207%20Enlarged%20Adrenal.jpg\" alt=\"IMAGE 7 Enlarged Adrenal\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\"><\/span><\/p>\n\n\n\n<p><strong><i><span data-contrast=\"auto\">Enlarged Adrenal Gland. <\/span><\/i><\/strong><i><span data-contrast=\"auto\">This sagittal plane image of the left adrenal in a dog shows enlargement of the adrenal gland. The digital callipers are placed to measure the width of the caudal pole.<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Adrenal gland hyperplasia is reported for patients undergoing therapy using trilostan.\u00a0<\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span data-contrast=\"auto\">Adrenal Gland Hypoplasia<\/span><\/strong><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/h4>\n\n\n\n<p><span data-contrast=\"auto\">Dogs with hypoadrenocorticism have a decreased adrenal gland size in comparison to normal dogs. In one study, a left adrenal thickness of less than 3.2mm was suggestive of hypoadrenocorticism.\u00a0<\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span data-contrast=\"auto\">Adrenal Gland Neoplasia<\/span><\/strong><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/h4>\n\n\n\n<p><span data-contrast=\"auto\">Primary adrenal gland tumours include adenomas, adenocarcinomas, myelolipomas and phaeochromocytomas. The adrenal glands can also be a site for the metastatic spread of other neoplastic lesions.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Typically, unilateral enlargement of one adrenal gland will be seen. However, overlap in the appearance of adrenal conditions causing hyperplasia and neoplasia is possible. Ultrasonography does not show whether lesions are hormonally active or not and so ultrasound findings should always be interpreted alongside the patient history, clinical examination, and laboratory test results.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Adrenal gland neoplasia is more likely to be present than hyperplasia where the diameter of the gland \u2265 2cm<\/span><span data-contrast=\"auto\">4,7<\/span><span data-contrast=\"auto\">. Another study suggests that malignancy should be suspected when adrenal gland lesions are <\/span><span data-contrast=\"auto\">\u226520mm<\/span><span data-contrast=\"auto\"> in size<\/span><span data-contrast=\"auto\">8<\/span><span data-contrast=\"auto\">.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Mineralisation can be seen in some cases of adrenal neoplasia. However, it is not specific for malignancy.\u00a0<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">A feature of malignant adrenal neoplasms is local invasion of blood vessels. This is more commonly seen in lesions of the right adrenal gland due to the close proximity of the caudal vena cava. Assessment of the local vasculature using ultrasound can identify lesions within blood vessels, and Doppler ultrasound can be used to document the lack of blood flow within vascular structures.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/7971300.fs1.hubspotusercontent-na1.net\/hubfs\/7971300\/IMAGE%208%20Adrenal%20Neoplasia.jpg\" alt=\"IMAGE 8 Adrenal Neoplasia\" loading=\"lazy\" \/><\/figure>\n\n\n\n<p><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><strong><i><span data-contrast=\"auto\">Neoplasia of the Right Adrenal Gland. <\/span><\/i><\/strong><i><span data-contrast=\"auto\">This sagittal plane image shows a hypoechoic mass in the region of the right adrenal gland (red arrow). There is invasion of the adjacent caudal vena cava (blue arrow) and interruption to the blood flow within the vena cava can be seen (red asterisk) by the lack of coloured pixels within the colour doppler sample gate (yellow box).<\/span><\/i><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><span data-contrast=\"auto\">Sampling Considerations<\/span><\/strong><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/h4>\n\n\n\n<p><span data-contrast=\"auto\">Historically, ultrasound guided fine needle aspiration of adrenal gland lesions has not been commonly undertaken, due to the risk of a hypertensive crisis caused by the sampling of adrenal phaeochromocytomas<\/span><span data-contrast=\"auto\">9<\/span><span data-contrast=\"auto\">, as well as due to risks of haemorrhage from the procedure.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">However, some recent studies have shown the procedure to be a \u201cminimally risky procedure\u201d<\/span><span data-contrast=\"auto\">9<\/span><span data-contrast=\"auto\"> or \u201crelatively safe\u201d<\/span><span data-contrast=\"auto\">10<\/span><span data-contrast=\"auto\">. A 23- to 25-gauge 1.5-inch needle can be used for fine needle aspirates.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">&nbsp;<\/span><\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><span style=\"text-decoration: underline;\">References&nbsp;<\/span><\/h5>\n\n\n\n<ol class=\"wp-block-list\">\n<li><span data-contrast=\"auto\">Benigni L. (2012) Adrenal glands. In: BSAVA manual of canine and feline ultrasonography. Eds. Barr F., Gaschen L. Gloucestershire: British Small Animal Veterinary Association, pp 147\u2013154.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Soulsby S.N., Holland M., Hudson J.A., Behrend E.N. (2014) Ultrasonographic evaluation of adrenal gland size compared to body weight in normal dogs. <\/span><i><span data-contrast=\"auto\">Veterinary Radiology and Ultrasound <\/span><\/i><strong><span data-contrast=\"auto\">56<\/span><\/strong><span data-contrast=\"auto\">: 317-326.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Griffin S. (2021) Feline Abdominal Ultrasonography: What\u2019s Normal? What\u2019s Abnormal? The Adrenal Glands. <\/span><i><span data-contrast=\"auto\">Journal of Feline Medicine and Surgery<\/span><\/i> <strong><span data-contrast=\"auto\">23<\/span><\/strong><span data-contrast=\"auto\">: 33-49.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Nyland T.G., Neelis D.A., Mattoon J.S. (2015) Adrenal Glands, In: Small Animal Diagnostic Ultrasound 3rd edn., Eds. Mattoon J.S., Nyland T.G., Elsevier, St. Louis, pp 541-556.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Mantis P., Lamb C.R., Witt A.L., Neiger R. (2003) Changes in ultrasonographic appearance of adrenal glands in dogs with pituitary-dependant hyperadrenocorticism treated with trilostane. <\/span><i><span data-contrast=\"auto\">Veterinary Radiology and Ultrasound <\/span><\/i><strong><span data-contrast=\"auto\">44<\/span><\/strong><span data-contrast=\"auto\">: 682-685.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Wenger M., Mueller C., Kook P.H., Reusch C.E. (2010) Ultrasonographic evaluation of adrenal glands in dogs with primary hypoadrenocorticism or mimicking diseases. <\/span><i><span data-contrast=\"auto\">Veterinary Record<\/span><\/i> <strong><span data-contrast=\"auto\">167<\/span><\/strong><span data-contrast=\"auto\">: 207-210.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Besso J.G., Penninck D.G., Gliatto J.M. (1997) Retrospective ultrasonographic evaluation of adrenal lesions in 26 dogs. <\/span><i><span data-contrast=\"auto\">Vet Radiol Ultrasound<\/span><\/i> <strong><span data-contrast=\"auto\">38<\/span><\/strong><span data-contrast=\"auto\">: 448-455.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Cook A.K., Spaulding K.A., Edwards J.F. (2014) Clinical findings in dogs with incidental adrenal gland lesions determined by ultrasonography: 151 cases (2007-2010). <\/span><i><span data-contrast=\"auto\">Journal of the American Veterinary Medicine Association<\/span><\/i> <strong><span data-contrast=\"auto\">244<\/span><\/strong><span data-contrast=\"auto\">: 1181-1185.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Pey P., Diana A., Rossi F., Mortier J., Kafka U., Veraa S., Growth A., MacLellan M., Marin C., Fracassi F. (2020) Safety of percutaneous ultrasound-guided fine-needle aspiration of adrenal lesions in dogs: Perception of the procedure by radiologists and presentation of 50 cases. <\/span><i><span data-contrast=\"auto\">Journal of Veterinary Internal Medicine<\/span><\/i> <strong><span data-contrast=\"auto\">34<\/span><\/strong><span data-contrast=\"auto\">: 626\u2013 635.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n\n\n\n<li><span data-contrast=\"auto\">Sumne J.A., Lacorcia L., Rose A.M., Woodwar A.P., Carter J.E. (2018) Clinical safety of percutaneous ultrasound-guided fine-needle aspiration of adrenal gland lesions in 19 dogs. <\/span><i><span data-contrast=\"auto\">Journal of Small Animal Practice<\/span><\/i> <strong><span data-contrast=\"auto\">59<\/span><\/strong><span data-contrast=\"auto\">: 357-363.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/li>\n<\/ol>\n\n\n\n<h5 class=\"wp-block-heading\">Further Reading&nbsp;<\/h5>\n\n\n\n<p><span data-contrast=\"auto\">d\u2019Anjou M.A., Penninck D. (2015) Adrenals, In: Atlas of Small Animal Ultrasonography 2nd edn., Eds: Penninck D. and d\u2019Anjou M.A., John Wiley &amp; Sons, Chichester, pp 387-401.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;201341983&quot;:0,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Griffin S. (2021) Feline Abdominal Ultrasonography: What\u2019s Normal? What\u2019s Abnormal? The Adrenal Glands. <\/span><i><span data-contrast=\"auto\">Journal of Feline Medicine and Surgery<\/span><\/i> <strong><span data-contrast=\"auto\">23<\/span><\/strong><span data-contrast=\"auto\">: 33-49.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;201341983&quot;:0,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">&nbsp;<\/span><\/p>\n\n\n\n<p><span data-contrast=\"auto\">Nyland T.G., Neelis D.A., Mattoon J.S. (2015) Adrenal Glands, In: Small Animal Diagnostic Ultrasound 3rd edn., Eds. Mattoon J.S., Nyland T.G., Elsevier, St. Louis, pp 541-556.<\/span><span data-ccp-props=\"{&quot;134233117&quot;:true,&quot;134233118&quot;:true,&quot;201341983&quot;:0,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">&nbsp;<\/span><\/p>\n\n\n\n<p><a style=\"font-weight: bold;\" href=\"https:\/\/www.imv-imaging.co.uk\/products\/veterinary-ultrasound\/\" rel=\"noopener\">View our Ultrasound Products >><\/a><\/p>\n\n\n\n<p><span style=\"font-family: Arial, Helvetica, sans-serif;\">&nbsp; &nbsp;<\/span>&nbsp; &nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p><span data-contrast=\"auto\">The improved resolution of newer ultrasound systems has allowed visualisation of the adrenal glands with more regularity. <\/span><\/p>\n","protected":false},"author":15701,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","ep_exclude_from_search":false,"footnotes":""},"categories":[1353,1354],"class_list":["post-48088","post","type-post","status-publish","format-standard","hentry","category-imv-ultrasound","category-imv-small-animal"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.0 (Yoast SEO v26.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Ultrasonography of the Adrenal Glands<\/title>\n<meta name=\"description\" content=\"Ultrasonography of the Adrenal Glands. 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