Bilateral testicular adrenal rest tissue in congenital adrenal hyperplasia: US and MR features

Proto, G; Donna, A; Grimaldi, Franco; Mazzolini, Anna; Purinan, Alessandro; Bertolissi, F.

doi:10.1007/bf03343887

Cited by 38 publications

(31 citation statements)

References 9 publications

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“…Also, the lesions were isointense to muscle on T1-and T2-weighted images, features resembling normal adrenal glands. In previous reports of MR studies, similar features have been described, but Avila et al [8] also found 4 of 14 lesions that were hyperintense on T1, compared with normal testicular tissue [16,17]. Intravenous gadolinium resulted in enhancement of the lesions in 13 of 15 patients.…”

Section: Discussionsupporting

confidence: 57%

“…The testicular masses in CAH show altered echogenicity compared with normal testicular tissue: in most studies hypoechogenicity of the lesions is reported [5,6,8,9,12,13,14,15,16]. We found that echogenicity was related to lesion size: 17 of the 20 lesions <2 cm where hypoechoic, whereas all lesions >2 cm were hypoechoic with hyperechoic reflections.…”

Section: Discussionmentioning

confidence: 57%

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Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features

et al. 2003

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The purpose of this study was to investigate the prevalence of testicular adrenal rest tumours in patients with congenital adrenal hyperplasia (CAH), and to describe sonographic and MR features of these lesions. Seventeen postpubertal male CAH patients underwent scrotal sonography, with colour Doppler, and in 16 of them pre- and postcontrast enhanced T1- and T2-weighted MR images of the testes were obtained. Ultrasound revealed lesions in 16 of 17 patients (94%), bilateral in 10 patients and unilateral in 6 patients. The lesions were typically located adjacent to the mediastinum testis. The maximal diameter of the lesions varied from 2 to 40 mm. Margins were blurred in 11 of 31 lesions. Seventeen of the 20 lesions smaller than 2 cm in diameter were hypoechoic, whereas all 11 lesions larger than 2 cm showed hyperechoic reflections. On MR all lesions were isointense on T1- and hypointense on T2-weighted images and lesion margins were clearly defined. Enhancement of the lesions after intravenous contrast was seen in 13 of 15 patients. In our series the prevalence of testicular adrenal rest tumours in postpubertal CAH patients is much higher than in other reported studies. The lesions may develop from some small, hypoechoic, and multifocal nodules and coalesce to large hypoechoic lesions with hyperechoic reflections on ultrasound. As our results suggest that ultrasonography and MR show the lesions equally well, ultrasonography should be the method of first choice for detection and follow-up of these lesions, because it is the cheapest and quickest imaging technique. In case of a partial orchiectomy, MR is recommended because it shows lesion margins optimally.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 57%

Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features

et al. 2003

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“…Most of these lesions are located inside of or close to the testicular hilus (86%), and they are usually bilateral (83%-100%). 2 Magnetic resonance imaging (MRI) can be used as a problem-solving modality in difficult cases. On MRI, these testicular adrenal rests are isointense on longitudinal relaxation time-weighted images and hypointense on transverse relaxation time-weighted images and are diffusely enhanced on post-gadolinium-enhanced images.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Appearance of Testicular Adrenal Rest Tissue in Congenital Adrenal Hyperplasia

Dogra

Nathan

Bhatt

2004

J of Ultrasound Medicine

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“…Congenital testicular adrenal rests are seen in about 29% of patients with congenital adrenal hyperplasia (CAH) (54,55). CAH is an autosomal recessive disease characterized by a deficiency of adrenocortical enzymes, particularly 21-hydroxylase.…”

Section: Congenital Testicular Adrenal Restsmentioning

confidence: 99%

“…15) (54). Intratesticular masses are typically located in the region of the mediastinum testis (in 86%) (55). Ultrasound is the modality of choice for their diagnosis; however, MRI can also assist as a problem-solving modality in some cases.…”

Section: Congenital Testicular Adrenal Restsmentioning

confidence: 99%

Non neoplastic intratesticular masses

Bhatt¹,

Jafri²,

Wasserman³

et al. 2009

Diagn Interv Radiol

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High-frequency ultrasonography is the first modality of choice for the evaluation of scrotal pathology. The use of high-frequency ultrasound is increasing, allowing detection and better characterization of many benign intrascrotal lesions that can be treated with non-surgical management or testicular-sparing surgery.This pictorial essay presents gray-scale and color-flow Doppler features of non-neoplastic intratesticular masses. For ease of understanding, the review is organized into three major categories: cystic, vascular, and solid non-neoplastic masses. Table summarizes the key sonographic features, each with recommended management. Sonographic anatomy of the testisThe normal adult testes in each hemi scrotum are symmetric in size and measure approximately 5x3x2 cm. On ultrasound, a normal testis is identified by the presence of homogeneous, medium-level echoes and is contained by a fibrous sheath called the tunica albuginea. The tunica albuginea is identified on ultrasound as a thin echogenic line around the testis and is externally covered by the tunica vaginalis. The tunica vaginalis consists of visceral and parietal layers that are normally separated by a few milliliters (2-3 mL) of fluid. The tunica attaches to the scrotal wall at the posterolateral aspect of the testis. From the posterior aspect of the testis, the tunica albuginea invaginates within the testis to form an incomplete septum, called the mediastinum testis. Sonographically, the mediastinum testis appears as an echogenic band of variable thickness that extends across the testis in the longitudinal axis (Fig. 1). Multiple fibrous septa extend from the mediastinum into the testis, dividing it into 250 to 400 lobules. Spermatogenesis occurs within the seminiferous tubules contained within these lobules. The seminiferous tubules open into dilated spaces called the rete testis within the mediastinum via the tubuli recti. The normal rete testis can be seen on high-frequency US in 18% of patients. (1). The rete testis drains into the epididymis via 10 to 15 efferent ductules.There are four testicular appendages (remnants of the mesonephric and paramesonephric ducts): the appendix testis (hydatid of Morgagni), the appendix epididymis, the vas aberrans, and the paradidymis. The appendix testis and the appendix epididymis are commonly seen on scrotal US. The appendix testis is a small ovoid structure usually at the upper pole of the testis in the groove between the testis and the epididymis, better seen by the presence of fluid around the testis.The testes are supplied by testicular arteries that arise from the abdominal aorta. The testicular arteries enter the spermatic cord at the deep inguinal ring and continue along the posterior surface of the testis, penetrating the tunica albuginea and forming the capsular arteries that course through the tunica vasculosa, which underlies the tunica ABDOMINAL IMAGING PICTORIAL ESSAY Imaging of non-neoplastic intratesticular massesShweta Bhatt, Syed Zafar H. Jafri, Neil Wasserman, Vikram S. Dogra ABSTRACTThe u...

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Bilateral testicular adrenal rest tissue in congenital adrenal hyperplasia: US and MR features

Cited by 38 publications

References 9 publications

Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features

Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features

Sonographic Appearance of Testicular Adrenal Rest Tissue in Congenital Adrenal Hyperplasia

Non neoplastic intratesticular masses

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