Adrenal Hemangioma

Hemangiomas can uncommonly affect the adrenal glands and are not hormonally active. They occur in people between the ages of 50 and 70 years, more commonly in women. Adrenal hemangiomas are well delimited and encapsulated and usually involve the cortex.

Radiographs reveal calcifications in more than half of cases, and CT reveals these calcifications to be phleboliths. For this reason, CT is preferred over MRI, as calcifications can suggest the diagnosis but are poorly seen with MRI. CT also shows multiple low-attenuation areas corresponding to necrotic cavities. Peripheral contrast enhancement is also seen; however, unlike liver hemangiomas, centripetal enhancement is not commonly seen due to the higher frequency of central necrosis and fibrosis.

On MR, adrenal hemangiomas present as heterogeneous, T1-hypointense, T2-hyperintense lesions with central fibrotic areas. There is peripheral contrast enhancement with centripetal enhancement being uncommon, as explained above.

Differential consideration at imaging include malignant hemangioblastoma, adrenal carcinoma, pheochromocytoma, and neuroblastoma. Metastases and tuberculosis can also show calcifications and should be considered.

References

• Marotti M, Sucić Z, Krolo I, Dimanovski J, Klarić R, Ferencić Z, Karapanda N, Babić N, Pavleković K. Adrenal cavernous hemangioma: MRI, CT, and US appearance. Eur Radiol. 1997;7(5):691-4.
• Otal P, Escourrou G, Mazerolles C, Janne d'Othee B, Mezghani S, Musso S, Colombier D, Rousseau H, Joffre F. Imaging features of uncommon adrenal masses with histopathologic correlation. Radiographics. 1999 May-Jun;19(3):569-81.