Research Article
Volume 3 Issue 7 - 2020
Imaging Features of Testicular Adrenal Rest Tumors in Patients with Congenital Adrenal Hyperplasia: Our Experience and Literature Review
Ammar Ashraf1, Aida Saeed Al Jabri2, Ahmed Fathi Eid3, Ahmed Mohamed Abdelrahman4, Shaden Saleh Al Mousa5, Nelson Ervine Mc Candless6 and Abdulhameed Ahmed H Alwabari7
1Staff Physician, Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
2Consultant Pediatric Endocrinologist, Department of Pediatric Medicine, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
3Consultant Radiologist and Chairman Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
4Staff Physician, Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
53rd Year Radiology Resident, Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
6Sonologist and Manager of Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
7Senior Technologist and Supervisor of MRI Section, Department of Medical Imaging, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia
*Corresponding Author: Ammar Ashraf, Department of Medical Imaging and Pediatric Endocrinology, Ministry of National Guard Health Affairs, King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia.
Received: June 13, 2020; Published: June 30, 2020




Abstract

Aim: Our motive was to evaluate the sonographic and magnetic resonance imaging features of testicular adrenal rest tumors (TARTs) in patients with congenital adrenal hyperplasia, to improve the diagnostic efficiency of these rare testicular lesions.

Methods: We found five male patients of congenital adrenal hyperplasia from our hospital database. All patients were young adolescents (age range = 14 - 16 years), had baseline scrotal ultrasound and MRI and follow up scrotal ultrasound examinations. 4 out of 5 patients had testicular lesions both in the US as well as MRI. All (4) positive cases had bilateral testicular lesions, located near the testicular mediastinum. US and MRI features of these 8 TART lesions in 4 patients were analyzed. We also conducted a literature review of TART in CAH patients.

Results: Key sonographic features of TARTs were: similar heterogeneously hypoechoic bilateral testicular lesions, located near the mediastinum, clear margins, no mass effect and normal testicular vessels coursing through the lesions. Key MRI features were: bilateral testicular lesions with low signal intensity on T2-weighted images, no diffusion restriction and homogenous enhancement (more than the normal testicular parenchyma) on post-contrast T1-weighted images. These features can help radiologists to make an accurate diagnosis of TART.

Conclusion: TARTs are frequently seen in males with congenital adrenal hyperplasia and are often misdiagnosed as malignant primary or other more common benign testicular tumors. Scrotal US and MRI are reliable imaging modalities for diagnosis and follow up of TARTs, with the US, being the initial preferable imaging modality of choice. Screening scrotal ultrasound can be recommended in all males with classic CAH, from the onset of puberty, to avoid future complications, especially infertility. TARTs have a typical imaging appearance that every radiologist must be aware of.

Keywords: Congenital adrenal hyperplasia; Testicular adrenal rest tumor; Ultrasound; Magnetic resonance imaging

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Citation: Ammar Ashraf., et al. “Imaging Features of Testicular Adrenal Rest Tumors in Patients with Congenital Adrenal Hyperplasia: Our Experience and Literature Review”. EC Clinical and Medical Case Reports 3.8 (2020): 42-57.

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