QUIZ: No. 9, 27/04/2025

CT PLAIN

ANS – Adrenal tuberculosis

Findings: Bilateral adrenal thickening with central non-enhancing low-density and peripheral rim contrast enhancement with relatively preserved adrenal contour. No calcification seen (usually seen in the chronic stage).

Early-stage adrenal TB presents with bilateral asymmetric adrenal enlargement with variable post-contrast enhancement. Central necrotic areas may be seen. In advanced stages, atrophy and calcification are the usual imaging manifestations.

As the tuberculous infection causes destruction of the adrenal cortex, primary adrenal insufficiency (PAI) develops. PAI manifesting as clinically inadequate production or action of glucocorticoids, when at least 90 percent of the adrenal cortex has been destroyed

DDs bilaterally enlarged adrenal glands

1.     Hyperplasia

2.     Metastases

3.     Granulomatous disease

4.     Lymphoma

5.     Hemorrhage

P.S – CT guided biopsy of right adrenal mass showed caseating granulomas and stained positively for acid-fast bacilli.