Adrenal calcifications can be seen with:
- Prior hemorrhage: Due to trauma (most common cause), anticoagulation, sepsis, blood dyscrasias or surgery. Calcification may be peripheral to a soft tissue mass of old blood or may diffusely involve a shrunken adrenal gland. Hemorrhagic degeneration of adenomas is uncommon. Hemorrhage in an adrenal hemangioma (see below) can cause irregular or nodular calcifications.
- Infection: Prior tuberculosis or other granulomatous infection. Chronic adrenal abscess can peripherally calcify.
- Myelolipoma: Benign neoplasm with hematopoetic tissue and macroscopic fat with or without calcification.
- Neuroblastoma: Can be heterogeneous due to necrosis and hemorrhage. Calcifications can be seen in up to 85%.
- Metastases: For example, from mucinous adenocarcinoma, osteosarcoma, or papillary thyroid carcinoma.
- Pheochromocytoma: Large lesions can have hemorrhage, necrosis, and uncommonly (10% of cases) calcifications.
- Adrenal hemangioma: Rare and usually asymptomatic. May contain phleboliths. Irregular or nodular calcification can be seen due to prior hemorrhage.
- Adrenal cortical carcinoma: Rare neoplasm with varying degrees of hemorrhage, necrosis, and calcification. Calcification can be coarse or in the form of microcalcification, and is seen on CT in ~30% of cases. The calcification is usually centrally located.
- Mature teratoma: Rare in the adrenal gland. Look for fluid, macroscopic fat, and calcification. Fat-fluid level is a characteristic, but may be difficult to differentiate from a myelolipoma.
- Adrenal Cyst: Well-defined, non-enhancing water-attenuation mass with or without eggshell calcification.
- Wolman disease: Rare autosomal recessive disease that is usually fatal by 6 months of age. Look for hepatosplenomegaly and enlarged adrenal glands due to infiltration by foam cells containing cholesterol and triglycerides.
References
Adrenal calcifications can be seen with:
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