Sonographic imaging of normal adrenal glands in children and adolescents. An analysis of forms and reflex properties

Abstract

168 sonographic examinations were performed in 156 children and adolescents for evaluation of the adrenal glands. For the ventrolateral approach, real-time sonography was used resulting in 99% visualisation of the adrenal glands on the right and 91% on the left side. In prone position, static scanning provided acceptable imaging of the right adrenal gland in 85% and the left in 95% of examinations. The "success rate" of transverse scanning was relatively low (67%) as compared to longitudinal sections. The reflective property of the adrenal glands was compared with the reflex intensity pattern of the adjacent parenchyma of the normal kidney. In 71% of examinations no distinction could be made between the adrenal glands and the upper pole of the kidney on the basis of echointensity. In 29% the adrenal gland was echolucent in comparison to the kidney's parenchyma. In no instance was the echointensity of the normal adrenal gland greater. Although the shape of the adrenal glands was found to vary according to the angle and position of the transducer, the most common appearance in children of one year or older was that of a triangle, helmet or cap. This caplike appearance and the similarity in echointensity often make it difficult or even impossible to distinguish the adrenal glands from the upper pole of the kidney. It is therefore advisable to examine the adrenal glands in children from both laterally and dorsally to allow for optimum visualization. In contrast to some reports in adults, increased echointensity of the adrenal gland (adrenal cortex) in children should be considered as an abnormal finding.(ABSTRACT TRUNCATED AT 250 WORDS)