Incidentaloma differential diagnosis: Difference between revisions

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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Clinical picture}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Imagings and labs}}
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Adrenal adenoma
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*  
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* Round and homogeneous density, smooth contour and sharp margination [15]
* Diameter less than 4 cm, unilateral location
* Low unenhanced CT attenuation values (<10 HU) (image 1)
* Rapid contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of more than 50 percent)
* Isointensity with liver on both T1 and T2 weighted MRI sequences
* Chemical shift evidence of lipid on MRI
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Adrenocortica'''l carcinoma
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*
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*  
*  
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* Irregular shape
* Inhomogeneous density because of central areas of low attenuation due to tumor necrosis (image 4)
* Tumor calcification
* Diameter usually >4 cm
* Unilateral location
* High unenhanced CT attenuation values (>20 HU)
* Inhomogeneous enhancement on CT with intravenous contrast
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* Hypointensity compared with liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI
* High standardized uptake value (SUV) on FDG-PET-CT study
* Evidence of local invasion or metastases
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Pheochromocytoma
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*  
*  
|
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* Increased attenuation on nonenhanced CT (>20 HU)
* Increased mass vascularity (image 2)
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* High signal intensity on T2 weighted MRI (image 3)
* Cystic and hemorrhagic changes
* Variable size and may be bilateral
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Adrenal metastasis
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*  
*  
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|
* Irregular shape and inhomogeneous nature
* Tendency to be bilateral
* High unenhanced CT attenuation values (>20 HU) and enhancement with intravenous contrast on CT
* Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
* Isointensity or slightly less intense than the liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI (representing an increased water content)
* Elevated standardized uptake value on FDG-PET scan
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Revision as of 02:03, 30 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

Differentiating Incidentaloma from other Diseases

  • [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3]
Differential Diagnosis Clinical picture Imagings and labs
Adrenal adenoma
  • Round and homogeneous density, smooth contour and sharp margination [15]
  • Diameter less than 4 cm, unilateral location
  • Low unenhanced CT attenuation values (<10 HU) (image 1)
  • Rapid contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of more than 50 percent)
  • Isointensity with liver on both T1 and T2 weighted MRI sequences
  • Chemical shift evidence of lipid on MRI
Adrenocortical carcinoma
  • Irregular shape
  • Inhomogeneous density because of central areas of low attenuation due to tumor necrosis (image 4)
  • Tumor calcification
  • Diameter usually >4 cm
  • Unilateral location
  • High unenhanced CT attenuation values (>20 HU)
  • Inhomogeneous enhancement on CT with intravenous contrast
  • Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
  • Hypointensity compared with liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI
  • High standardized uptake value (SUV) on FDG-PET-CT study
  • Evidence of local invasion or metastases
Pheochromocytoma
  • Increased attenuation on nonenhanced CT (>20 HU)
  • Increased mass vascularity (image 2)
  • Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
  • High signal intensity on T2 weighted MRI (image 3)
  • Cystic and hemorrhagic changes
  • Variable size and may be bilateral
Adrenal metastasis
  • Irregular shape and inhomogeneous nature
  • Tendency to be bilateral
  • High unenhanced CT attenuation values (>20 HU) and enhancement with intravenous contrast on CT
  • Delay in contrast medium washout (10 minutes after administration of contrast, an absolute contrast medium washout of less than 50 percent)
  • Isointensity or slightly less intense than the liver on T1 weighted MRI and high to intermediate signal intensity on T2 weighted MRI (representing an increased water content)
  • Elevated standardized uptake value on FDG-PET scan

References

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