Presentation
Pre-op imaging before resection of a high-grade vulvar lesion.
Patient Data
Bilateral thickening of adrenal glands, hypodense centrally with peripherally enhancing margins.
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.
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.
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.
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