Adrenal metastasis - lung cancer

Case contributed by Henry Knipe

Presentation

Adrenal mass on CT for further evaluation.

Patient Data

Age: 80 years
Gender: Female

Left adrenal nodule that is mildly low T1, and high T2 signal to the remainder of the adrenal gland. No significant loss of signal between T1 in phase and out of phase images with indeterminate CSI (0.87) and signal intensity index (11%). Arterial phase hypoenhancement with progressive heterogeneous enhancement on subsequent phases.

Cholelithiasis. Fatty infiltration of the pancreas. Tiny renal cortical cysts, no solid mass or hydronephrosis. Multilevel degenerative changes in the lumbar spine with Modic type I changes at L2-3 endplates.

F18 FDG PET-CT

Nuclear medicine

Intensely FDG avid pulmonary mass in the medial right upper lobe consistent with a primary pulmonary malignancy.

FDG avid right lower paratracheal mediastinal nodal metastasis.

FDG avid left adrenal metastasis is demonstrated.

FDG avid vertebral metastasis in the T4 vertebra. 

Status post right posterior fossa craniotomy.  

Case Discussion

The adrenal lesion was identified incidentally on a spine MRI. After the spine MRI but before the adrenal MRI, the patient presented with headaches and a brain tumor was discovered, resected with the pathology consistent with a lung cancer metastasis. Subsequent PET findings are consistent with metastatic lung cancer. 

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