Left Adrenal mass in an 11 year old, MN, Maltese
An 11-year-old MN Maltese mix was presented for evaluation of progressive elevation of liver enzyme activity. Blood work showed elevated ALT (530) and ALP (1255) activity and mildly elevated cholesterol.
Clinical Differential Diagnosis
The right adrenal gland was normal in size and contour measuring 2.04 x 0.69 cm at the caudal pole and 0.67 cm at the cranial pole. The left adrenal gland comprised a mixed, hypoechoic, expansive mass with pericapsular fat enhancement. The mass measured 1.83 x 1.77 cm. The left adrenal gland itself measured 2.94 x 1.7 cm at the caudal pole and 0.78 cm at the cranial pole. There was no evidence of vascular invasion with the adrenal mass.
The kidneys revealed largely normal size and structure, corticomedullary definition and ratio (cortex 1/3 of medulla) were essentially maintained with some age-related loss of curvilinear patterns regarding the capsule and C/M junction. The cortices presented largely uniform texture with some increased echogenicity expected for this age patient. Medullary structure differed distinctly from that of the cortex and no evidence of pelvic dilation was present. The left kidney measured 5.5 cm. The right kidney measured 6.06 cm.
The base and limbs of the pancreas were observed to be largely isoechoic to surrounding omental fat. Some parenchymal remodeling, however, with mild deviation from curvilinear normalcy was observed. Pancreatic duct and capsular irregularities were present consistent with age related changes. If pain upon imaging (+ Murphy sign) was present or if the patient is focally painful in subxiphoid palpation then low-grade smoldering chronic pancreatitis should be suspected.