Question 1689

{"accessible":false,"alternatives":[{"id":8399,"text":"pheochromocytoma"},{"id":8400,"text":"renal cell carcinoma (RCC) metastasis"},{"id":8401,"text":"adrenal adenoma"},{"id":8402,"text":"hepatocellular carcinoma (HCC) metastasis "},{"id":8403,"text":"all the above"}],"archived":false,"correctAlternativeId":8403,"explanation":"\u003cp\u003eAlthough applied for the differentiation of \u003ca title=\"adrenal adenomas\" class=\"internal\" href=\"/articles/adrenal-adenomas\"\u003eadrenal adenomas\u003c/a\u003e from non-adenomatous lesions, dynamic post-contrast CT scans of the adrenal glands can be misleading if its assessment is made\u0026nbsp;purely based on washout values.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003eAll the tumors listed above can present with rapid washout similar to an adenoma (absolute washout \u0026gt;60% and relative washout \u0026gt;40%).\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003ca title=\"Pheochromocytomas\" class=\"internal\" href=\"/articles/phaeochromocytoma-1\"\u003ePheochromocytomas\u003c/a\u003e normally have a slow washout, but in a few cases can present with values that fulfill the criteria for adenoma. They\u0026nbsp;should have a different clinical presentation and also may have a higher absolute attenuation on the contrast phase (arterial or portal venous).\u0026nbsp;\u003c/p\u003e\u003cp\u003eHypervascular metastases may show rapid washout values, particularly those from\u0026nbsp;\u003ca href=\"https://radiopaedia.org/articles/renal-cell-carcinoma-tnm-staging?lang=gb\"\u003erenal cell carcinoma\u003c/a\u003e\u0026nbsp;and\u0026nbsp;\u003ca href=\"https://radiopaedia.org/articles/hepatocellular-carcinoma?lang=gb\"\u003ehepatocellular carcinoma\u003c/a\u003e. An alternative diagnosis to adrenal adenoma must be considered when there is a value \u0026gt;120 HU\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eon the portal venous phase, particularly in cases with a prior history of neoplasm.\u0026nbsp;\u003c/p\u003e","id":1689,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/1689","nextQuestionPath":"/articles/adrenal-metastasis-1/questions/1147","relatedArticles":[{"id":862,"title":"Adrenal adenoma","link":"/articles/adrenal-adenoma?lang=us"},{"id":34779,"title":"Adrenal washout","link":"/articles/adrenal-washout?lang=us"},{"id":8642,"title":"Pheochromocytoma","link":"/articles/phaeochromocytoma-1?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eWhich of the following adrenal gland lesions can potentially demonstrate rapid contrast washout on dynamic CT scans?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1689"}],"attemptsPercentages":[{"alternativeId":"8399","percentage":10},{"alternativeId":"8403","percentage":60},{"alternativeId":"8401","percentage":24},{"alternativeId":"8402","percentage":4},{"alternativeId":"8400","percentage":2}],"promptToLogin":false,"questionManager":false,"articleId":"adrenal-metastasis"}