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Identification of Adrenal Tumor by Ultrasonic Tomography

The preoperative identification of adrenal tumor is essential to determine the method of surgical operation. For this purpose, retroperitoneal pneumography, adrenal venography, determination of hormone concentration in adrenal venous blood, adrenal arteriography or adrenal scintigraphy has been used. It was recently reported that ultrasonic tomography identified a pheochromocytoma 3 cm in diameter. So this study examined whether a smaller adrenal tumor could be visualized by this method or not. Sonograms in this study were obtained with a Toshiba SSL-21A or SSL-51U unit with a P.Z.T. transducer 10 mm in diameter operated as a contact scanner at 2 MHz. Patients were examined in the prone position. This placed the suprarenal region closer to the transducer and also eliminated the interfering effect of a gas-filled bowel. Sonograms were obtained with sagittal scan along each renal axis through the suprarenal region. A series of scans was conducted at 0.5 mm intervals. Ultrasonic tomography was taken in 10 normal subjects, 6 patients with essential hypertension, 10 patients with primary aldosteronism and a patient with Cushing's syndrome. In 9 of 11 patients with adrenal tumor it was taken by reference to the findings of adrenal venography and in the other 2 patients before adrenal venography was performed. In the echograms of 10 normal subjects and 6 patients with essential hypertension, the suprarenal regions were filled with echoes and adrenal glands were not visualized as discriminative structures. In 9 patients with primary aldosteronism and a patient with Cushing's syndrome, adrenal tumors were visualized as a sonically homogenous suprarenal mass. In a case of primary aldosteronism the border between tumor and kidney was not visualized distinctly. The size of the adrenal tumors obtained surgically ranged between 1.0 cm and 3.0 cm in diameter. In conclusion, there is a possibility that smaller adrenal tumors such as aldosteronoma also can be identified by ultrasonic tompgraphy in some instances.