CT Findings in Mycobacterial and Fungal Infection of the Adrenal Glands
Keywords:Adrenal tuberculosis, Adrenal histoplasmosis, CT
Introduction: To determine the CT findings of mycobacterial and fungal infection of the adrenal gland.
Methods: CT findings of patients with mycobacterial and fungal infection at adrenal glands were reviewed retrospectively by two reviewers, independently. Several CT parameters were recorded. Quantitative parameters were reported as mean, range, and standard deviation. Qualitative parameters were reported as percentage. The Kappa statistic was used to assess interobserver agreement.
Results: Seventeen patients, 8 with adrenal tuberculosis, 7 with adrenal histoplasmosis, 1 with adrenal cryptococcosis, and 1 with adrenal non-tuberculous mycobacterial infection, were included. Nine patients (52.9%) had primary adrenal insufficiency which are found only in adrenal tuberculosis and adrenal histoplasmosis groups. The CT findings that found in adrenal tuberculosis and adrenal histoplasmosis groups are bilateral involvement (100%), enlarged size of adrenal gland/mass forming lesion (100%), multiloculated abscess or necrosis (75% and 57.1%), and perilesional fat stranding (75% and 85.7%). The interobserver agreements are good to excellent with Kappa of 0.81 - 1.00.
Conclusions: Many CT findings are found in mycobacterial and fungal infection of adrenal glands, such as bilateral involvement, enlarged size of adrenal gland/mass forming lesion, multiloculated abscess/necrosis, and perilesional fat stranding. It is difficult to diagnose the mycobacterial and fungal infection by CT imaging. The clinical correlation, laboratory, and pathologic findings are needed to diagnose the etiology of primary adrenal insufficiency.