Why is adrenal ultrasound such a difficult ultrasound?

The article is professionally consulted by Master, Doctor Le Xuan Thiep - Department of Diagnostic Imaging - Vinmec Ha Long International Hospital

The adrenal gland is a small organ located on top of each kidney. The adrenal lip is divided into two main parts, the adrenal cortex and the adrenal medulla.
Adrenal cortex consists of 3 layers: glomerulus (outer layer), fibrous layer (middle part), reticular layer (inner part)
Adrenal medulla belongs to the sympathetic nervous system, including modified postganglionic neurons, only the trunk has no dendrites, the axon is innervated by the preganglionic fibers of the sympathetic system.
The size of the adrenal gland is about the size of a walnut. Cells located in different regions make different hormones.

The adrenal gland has the function of secreting the hormones adrenalin and cortisol to help balance the body, fight stress, regulate blood pressure stably...
The hormones adrenalin, cortisol tend to increase sugar levels, partly through the ability to control the process of converting non-sugar fuels such as amino acids (the main building blocks of protein) into glucose, performing the process of controlling the activity of the immune system...
The adrenal gland also secretes the hormone DHEA (dihydroepiandrosterone) and aldosterone. DHEA has the effect of regulating the body, strengthening and repairing protein molecules in cell and muscle tissue, repairing tissue when injured or infected, in addition, DHEA can also convert into other hormones. such as testosterone and oestrogen. Sdosterone is responsible for controlling minerals in the body, protecting sodium levels in the body, stimulating potassium depletion, maintaining fluid levels and blood pressure.

Adrenal gland disease can include adrenal insufficiency, which leads to other effects that affect health.
3.1 Signs of adrenal insufficiency The body is tired, stressed, sluggish... Dark skin Feeling of mental and physical stress, health is increasingly feeling weaker Low blood pressure, clearly manifest obvious when suddenly from lying to standing position.

3.2 Causes of adrenal insufficiency Due to the damaged part of the adrenal cortex, it cannot meet the amount of hormone required by the body. The most common cause is an autoimmune disease, in which the body's immune system considers the adrenal gland to be a foreign object, so it attacks and destroys it.
Other causes may be due to tuberculosis or bacterial adrenalitis, cancer metastasis to the adrenal gland, adrenal congestion...

Ultrasound of the adrenal gland is much more difficult than ultrasound in other locations because:
The size of the adrenal gland is small, the location of the adrenal gland is located very deep retroperitoneally, it is necessary to know the anatomical position. to reveal them clearly on ultrasound. The doctor must identify, find the adrenal fossa, it is an area of ​​hyperechoic fat surrounding the gland, define it on 3 layers: Transverse, longitudinal, and lateral (forehead plane) cuts: Above: Cross section:
Right adrenal gland is located behind the inferior vena cava, the sections scan from top to bottom and from bottom to top in the upper pole of the right kidney.
Gastric air is often superimposed in front of the left adrenal so the technician performing the ultrasound needs to press the transducer firmly for a while to deflate the stomach and make the gas inside the stomach push away, or The patient drinks plenty of water to fill the stomach, creating the adrenocortical window at the back of the stomach.
On sagittal or oblique sections :
Cuts with longitudinal axis downward and outward follow the lateral or subcostal intercostal line to see the superior renal pole, the hypoechoic adrenal fossa is triangular in shape above the pole. upper kidney.

Lateral section:
Ultrasonography, using an anterior to posterior transducer scanner that passes through the great vessels (left abdominal aorta, right inferior vena cava) to the plane of passage through the kidney behind.
Ask the patient to take a deep breath and hold their breath to make the liver and spleen lower to help have a window to examine the adrenal gland.
In addition, when ultrasound has many images similar to adrenal gland or adrenal tumor, such as when ultrasound is located at the fundus of the stomach, accessory spleen, bends of the splenic artery, pole tumor on the kidney, tumor in the back pancreas, pathological lymph nodes, diaphragm, varicose veins under the left bulb, tumors located next to the adrenal glands, aneurysms, gastrointestinal tract... all give a pseudo-adrenal or adrenal tumor. in the left area.
In case it is difficult to determine by ultrasound, the doctor will check with computerized tomography technique.
Ultrasound to detect and diagnose problems related to the adrenal gland is difficult and easy to misdiagnose, requiring technicians and doctors to perform with expertise and high experience. Vinmec International General Hospital is a high-quality medical facility in Vietnam, equipped with international standard facilities to help bring comfort to patients during examination and treatment. With the most modern medical equipment along with a team of highly qualified doctors and nurses, it helps to diagnose and treat quickly and effectively.
To be examined by experienced specialists at Vinmec. Please make an appointment at the website to be served.