Case Report
A Retroperitoneal Leiomyosarcoma Presenting as an Adrenal Incidentaloma in a Subject on Warfarin
Table 1
Adrenal imaging modalities and their utility.
| Scan type | Diagnostic characteristics | Comments |
| Contrast enhanced ultrasound | Arterial enhancement and rapid washout seen in nonadenomatous lesions | Not commonly used |
| Unenhanced CT scan | (a) Presence of macroscopic fat seen in myelolipoma (b) Attenuation of less than 10 Hounsfield units (HU) seen in benign adrenal adenomas | Commonly used scan mode but 30–40% benign lesions are lipid poor |
| Multiphase CT | (a) Rapid washout, benign lesions (b) Slower washout, malignant lesions | Useful when unenhanced CT is equivocal |
| MRI | Chemical shift imaging is helpful in differentiating between lipid poor adenomas and malignant adrenal lesions | Helpful when CT is contraindicated or washout values are equivocal |
| Positron emission tomography (PET) and PET-CT | Differentiate benign from malignant lesions with high sensitivity and specificity | Combine HU measurement with functional activity |
|
|