Focal Adrenal Lesions in Pediatric Patients

Abstract

Diaphragmatic lesions F ocal adrenal lesions can occur from a variety of underlying congenital and acquired causes in the pediatric population. Although some lesions are discovered incidentally in asymptomatic individuals on imaging studies obtained for other reasons, the majority of pediatric patients with focal adrenal lesions have abdominal pain and a palpable mass. In the neonatal period, the initial imaging modality of choice in the workup of suspected adrenal pathology is ultrasound because of an available acoustic window to visualize suprarenal fossa, easy accessibility, and lack of ionizing radiation. In older children, however, CT or MRI is usually required after initial ultrasound for confirmation and further characterization of adrenal lesions. When generating a differential diagnosis for focal adrenal lesions in the pediatric population, it is important to consider not only congenital, neoplastic, infectious, and traumatic conditions but also the potential mimics of focal adrenal lesions that may present in the suprarenal fossa region (Table 1). The age of the patient, clinical history, and laboratory data can further help narrow the differential diagnosis.