IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Adrenal histoplasmosis

Case contributed by Francis Fortin
Diagnosis almost certain

Presentation

Pre-op imaging before resection of a high-grade vulvar lesion.

Patient Data

Age: 60 years
Gender: Female

Initial CT

ct

Bilateral thickening of adrenal glands, hypodense centrally with peripherally enhancing margins.

MRI 1 month later

mri

Slightly T2-hyperintense diffuse thickening of the adrenal glands with significant restricted diffusion and no signal drop between T1 in- and out-of-phase sequences. Subtraction images after contrast administration show only peripheral enhancement with central non-enhancement.

PET-CT same week as MRI

Nuclear medicine

The adrenal thickening shows high FDG uptake on PET-CT.

Subsequent investigations, on the basis of ground-glass opacities on chest CT (not shown) revealed Histoplasma capsulatum on bronchoalveolar lavage.

CT 6 months later

ct

Six months after treatment for histoplasmosis, the adrenal glands have returned to a normal appearance with resolution of the previously-noted hypodense thickening.

Case Discussion

Adrenal histoplasmosis can present with bilateral hypodense thickening of the adrenal glands on CT. Patients are at risk for subsequent adrenal insufficiency.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.