Adrenal histoplasmosis

Case contributed by Dr Francis Fortin

Presentation

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

Patient Data

Age: 60 years
Gender: Female
CT

Initial CT

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

MRI

MRI 1 month later

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.

Nuclear medicine

PET-CT same week as MRI

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

CT 6 months later

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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Case information

rID: 68894
Published: 24th Jun 2019
Last edited: 14th Aug 2019
System: Urogenital
Inclusion in quiz mode: Included

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