Add comprehensive documentation for adrenal conditions
- Created detailed articles for Adrenal Adenoma, Adrenal Cyst, Adrenal Myelolipoma, and general Adrenal anatomy. - Included key facts, imaging findings, differential diagnoses, pathology, clinical issues, and diagnostic checklists for each condition. - Enhanced understanding of adrenal tumors and their characteristics through structured documentation.
This commit is contained in:
Ross
@@ -0,0 +1,127 @@
|
|||||||
|
{
|
||||||
|
"8f740fe23a1f9a45b36059b689e856ceb3c10b43ee55b78be2aac5303c595c96": "docs_md/external/https-appstatdxcom_app.statdx.com__68c940ff_20251017T211704Z.meta.md",
|
||||||
|
"6783fbb02e973ac24cca6f83e9d137b370d2156f2236b9b4e6062e7ccad4f5ea": "docs_md/external/https-appstatdxcom-document-09ca9b54-a3d9-43fd-a9cc-4c0212b578a1-media_app.statdx.com_document_09ca9b54-a3d9-43fd-a9cc-4c0212b578a1_media_7fa3f9a1_20251014T204901Z.meta.md",
|
||||||
|
"559b1f5d3eba1b9750d68db3326a16df2fa079813b29f76ed9f5824022b4b6b1": "docs_md/external/https-appstatdxcom-document-12b32579-c99b-41c0-95fd-f2ad1fc4a4fd-media_app.statdx.com_document_12b32579-c99b-41c0-95fd-f2ad1fc4a4fd_media_2ef2abb7_20251014T202907Z.meta.md",
|
||||||
|
"132a6246376a8cc9e69228766db9c4a196cc7248c9ca86ea059483e6d4cda881": "docs_md/external/https-appstatdxcom-document-23de52b7-d9bd-441c-a18c-95c8afccb470-media_app.statdx.com_document_23de52b7-d9bd-441c-a18c-95c8afccb470_media_640e8e45_20251014T204657Z.meta.md",
|
||||||
|
"82ee80c12711edc70ffc31ebf506d82f756be2b84e718f69e951c61e7c2360ac": "docs_md/external/https-appstatdxcom-document-23de52b7-d9bd-441c-a18c-95c8afccb470-tables_app.statdx.com_document_23de52b7-d9bd-441c-a18c-95c8afccb470_tables_a484b4c4_20251014T204657Z.meta.md",
|
||||||
|
"aacaa46dfe4f51f6302099d5e6d3b853a75942f5418ed4fb2f830ee64b446309": "docs_md/external/https-appstatdxcom-document-24559f7a-ed5a-4ab6-90ba-769f0b5c1197-media_app.statdx.com_document_24559f7a-ed5a-4ab6-90ba-769f0b5c1197_media_68d0cff6_20251014T195936Z.meta.md",
|
||||||
|
"b37c794f3641c894fb2c8660747ada1559fc9a5e1b32836510f65589357c9361": "docs_md/external/https-appstatdxcom-document-2aad3ac4-44fd-43e5-8e50-a86987483af3-media_app.statdx.com_document_2aad3ac4-44fd-43e5-8e50-a86987483af3_media_93b3c006_20251014T193414Z.meta.md",
|
||||||
|
"2bc150a35fca859fcd8be1e211e74508f9e93a7f5d7c89310b796e8413d3f33f": "docs_md/external/https-appstatdxcom-document-2b99b31a-ec1a-4dce-bb63-2a101fe9f044-media_app.statdx.com_document_2b99b31a-ec1a-4dce-bb63-2a101fe9f044_media_c76d4e9f_20251014T193525Z.meta.md",
|
||||||
|
"75b9de4f6f835bc8051888cdd61df85158949eb123cf704f0c60f8fba75ce6c0": "docs_md/external/https-appstatdxcom-document-39a0d2d1-1439-4558-8f5d-86a2a6d93e3a-media_app.statdx.com_document_39a0d2d1-1439-4558-8f5d-86a2a6d93e3a_media_9cb0e971_20251014T204947Z.meta.md",
|
||||||
|
"cd77be566fab4b1d14b3c0ea43e67530d0260b46b6912db17561e36999678d88": "docs_md/external/https-appstatdxcom-document-4778fafe-9873-4c28-8f4f-299c00c72b50-media_app.statdx.com_document_4778fafe-9873-4c28-8f4f-299c00c72b50_media_ff79514f_20251014T204704Z.meta.md",
|
||||||
|
"82a71486da6df4ff81e77161cb35fe2fb563f297a55a71bd67ecfbe892c31bf3": "docs_md/external/https-appstatdxcom-document-49510d0e-acf7-45cb-9eb1-53f8193b0b6d-media_app.statdx.com_document_49510d0e-acf7-45cb-9eb1-53f8193b0b6d_media_00a64790_20251014T204710Z.meta.md",
|
||||||
|
"9c6e2263738e59593a52304ab0a67371b5464c947582ef980f12ed0bf7f26d38": "docs_md/external/https-appstatdxcom-document-49510d0e-acf7-45cb-9eb1-53f8193b0b6d-tables_app.statdx.com_document_49510d0e-acf7-45cb-9eb1-53f8193b0b6d_tables_19dabcac_20251014T204710Z.meta.md",
|
||||||
|
"1d48e82de0f4352714943824207c81f6bb59e2272c18c48c9622e99615f4f19e": "docs_md/external/https-appstatdxcom-document-5813a554-06a4-4696-af71-7ce50693039d-media_app.statdx.com_document_5813a554-06a4-4696-af71-7ce50693039d_media_0b54d39d_20251017T212345Z.meta.md",
|
||||||
|
"7babfed03c49edde5d00443c1783838a267c32d880406fde5b3ba176d7ee5802": "docs_md/external/https-appstatdxcom-document-6cb71737-f574-4121-a8fb-02eeada9f9f7-media_app.statdx.com_document_6cb71737-f574-4121-a8fb-02eeada9f9f7_media_a7fbcf7b_20251014T195847Z.meta.md",
|
||||||
|
"cc70569e8c4ecd1c18b5f6b008a4c1c20b86b63ec77125dbefa0042a0e34f616": "docs_md/external/https-appstatdxcom-document-78257543-6d52-4879-84b1-445f3611d996-media_app.statdx.com_document_78257543-6d52-4879-84b1-445f3611d996_media_2f9e2bbb_20251014T204752Z.meta.md",
|
||||||
|
"a863f5fa5e19d6b83c76506567103d4acc160428ec313917ff7f041b4e931fbd": "docs_md/external/https-appstatdxcom-document-7d64f5fb-c62c-4861-8ff4-654a12074605-media_app.statdx.com_document_7d64f5fb-c62c-4861-8ff4-654a12074605_media_44ed5888_20251014T202430Z.meta.md",
|
||||||
|
"213a241699c1efa5cd3b558e806ae96e169f6ead79a16f19d3aa7faf1cc951a9": "docs_md/external/https-appstatdxcom-document-7f85487f-9497-44a9-b884-b98e50d41018-media_app.statdx.com_document_7f85487f-9497-44a9-b884-b98e50d41018_media_f2029cbd_20251014T204849Z.meta.md",
|
||||||
|
"19821bf3e438c87c30551ba78fd40b80a2313ab946078f2c262efc592ccb4996": "docs_md/external/https-appstatdxcom-document-840ed321-c0ab-4069-a07e-ad416232f916-media_app.statdx.com_document_840ed321-c0ab-4069-a07e-ad416232f916_media_6c4131be_20251014T204602Z.meta.md",
|
||||||
|
"e0ddb24025036cf14ab45719650731dee26e1ef76daafffb10a31818852f6a1e": "docs_md/external/https-appstatdxcom-document-8bfa943b-c158-4a3b-9d43-e6ef057f45d4-media_app.statdx.com_document_8bfa943b-c158-4a3b-9d43-e6ef057f45d4_media_08746c1e_20251014T204445Z.meta.md",
|
||||||
|
"fb86e9b6bdec86b3e3307a3647c5c59987872be307824aa5e335fa74eadaf59f": "docs_md/external/https-appstatdxcom-document-8e3465d1-d058-48d8-863c-1fd85cc6caee-media_app.statdx.com_document_8e3465d1-d058-48d8-863c-1fd85cc6caee_media_079e5a6e_20251014T204533Z.meta.md",
|
||||||
|
"e11e8d088231e2fd34e20100bb5ad2adebe1ea99ab3059ffe2d9db3b4fc8458a": "docs_md/external/https-appstatdxcom-document-8f1561f7-92a7-485c-a0ae-2e2d5c8c1628-media_app.statdx.com_document_8f1561f7-92a7-485c-a0ae-2e2d5c8c1628_media_a2353309_20251014T204923Z.meta.md",
|
||||||
|
"509bdb49d64628cd4ed0dfc17757322592692cd5f3f5f9756db1708a7cd9b44e": "docs_md/external/https-appstatdxcom-document-9f9eda8c-7e3c-4292-9861-4b8abc2c6474-media_app.statdx.com_document_9f9eda8c-7e3c-4292-9861-4b8abc2c6474_media_23f69ac7_20251014T193351Z.meta.md",
|
||||||
|
"470aa453ed96f8620233a55268a23df09affa7ad67a1174764209da1bcb7f17b": "docs_md/external/https-appstatdxcom-document-a342e5b5-5b98-4003-a437-6d42a483b40e-media_app.statdx.com_document_a342e5b5-5b98-4003-a437-6d42a483b40e_media_e5d69417_20251014T204358Z.meta.md",
|
||||||
|
"ab7682a6cae98f509ced3f10a99c90f486bda4074878c81406eac88abf9d2be3": "docs_md/external/https-appstatdxcom-document-aa473236-a733-4f9b-8d92-267ab8d4bcd9-media_app.statdx.com_document_aa473236-a733-4f9b-8d92-267ab8d4bcd9_media_6a74a397_20251014T204510Z.meta.md",
|
||||||
|
"ed03db0d85cd49cee77b748d1e23fed73d3487ee7f11d604dd42f3ff16007e3b": "docs_md/external/https-appstatdxcom-document-c1e384b3-3c6e-4f67-bf79-5187bd6a1b86-media_app.statdx.com_document_c1e384b3-3c6e-4f67-bf79-5187bd6a1b86_media_f6ae7fb0_20251014T204642Z.meta.md",
|
||||||
|
"a4d8bfa4a9b9147632c7e8bd3ff14b72b04c14fb148ae8a0ccb13274466aba10": "docs_md/external/https-appstatdxcom-document-c5d717a3-3d6e-4e86-9efe-1ad0ec14740f-media_app.statdx.com_document_c5d717a3-3d6e-4e86-9efe-1ad0ec14740f_media_ad9f4f3c_20251017T212541Z.meta.md",
|
||||||
|
"d7f0687cf97e1acbabf128b56fcb5c262d27a290b871b7bbc85bf56d94d27a92": "docs_md/articles/craniopharyngioma_00e66680-6731-4287-b5a1-3f0b3f09053b.md",
|
||||||
|
"0a0984979937bf4f0b37e656d58fbba6713a94793456a8ff4a5a1618e976ad21": "docs_md/external/https-appstatdxcom-document-content-00e66680-6731-4287-b5a1-3f0b3f09053b_app.statdx.com_document_content_00e66680-6731-4287-b5a1-3f0b3f09053b_ff7f86be_20251014T205219Z.meta.md",
|
||||||
|
"c404c030c29e9f6b9dce68b4c4129ca396c3a71bb836bbc1d694812c1d8e9f0e": "docs_md/articles/adrenal_082ca43c-db5c-4770-aeed-0c6ea317e8fc.md",
|
||||||
|
"799574ced4cf2f0c1d5a3ea81f5f36e00d4a326a80cdc705bf1a20b993f3cbb1": "docs_md/external/https-appstatdxcom-document-content-082ca43c-db5c-4770-aeed-0c6ea317e8fc_app.statdx.com_document_content_082ca43c-db5c-4770-aeed-0c6ea317e8fc_79cc786d_20251017T212319Z.meta.md",
|
||||||
|
"941f2a3d2dd1349831c680dc843ef55cbe26fc3fffd2820cc13f6c4c57ebe30d": "docs_md/articles/pituitary-anomalies_09ca9b54-a3d9-43fd-a9cc-4c0212b578a1.md",
|
||||||
|
"8b4ff977853904917992b7b83b0a9eabd20d998ced657a02ecb36714606c84da": "docs_md/external/https-appstatdxcom-document-content-09ca9b54-a3d9-43fd-a9cc-4c0212b578a1_app.statdx.com_document_content_09ca9b54-a3d9-43fd-a9cc-4c0212b578a1_38ef7db5_20251014T204902Z.meta.md",
|
||||||
|
"1f3f5992a94f12ce80bbeb02780b34f25a79b35bbd93dcc5b7afa468b14c5804": "docs_md/articles/brain-tumor-in-newborn-infant_12b32579-c99b-41c0-95fd-f2ad1fc4a4fd.md",
|
||||||
|
"70105df6bfabf1f02393b025ac8f59fcc9ea6cb448ee3a36a0f162e7545f2135": "docs_md/external/https-appstatdxcom-document-content-12b32579-c99b-41c0-95fd-f2ad1fc4a4fd_app.statdx.com_document_content_12b32579-c99b-41c0-95fd-f2ad1fc4a4fd_d27108e0_20251014T202907Z.meta.md",
|
||||||
|
"b35301d123342f032e80a89cb636b59b9c7f7ed2e51012ab010a0dd522be84f7": "docs_md/articles/amyotrophic-lateral-sclerosis-als_23de52b7-d9bd-441c-a18c-95c8afccb470.md",
|
||||||
|
"707fe0aa2c588cbd8f4961319c09ca37f4ee8907a2e335e4b19edc962ca207d9": "docs_md/external/https-appstatdxcom-document-content-23de52b7-d9bd-441c-a18c-95c8afccb470_app.statdx.com_document_content_23de52b7-d9bd-441c-a18c-95c8afccb470_43cf20f0_20251014T204657Z.meta.md",
|
||||||
|
"3fc2e5bd0e1fd66e55160ab2a1436812110d477e37848a140d012212b7d494ed": "docs_md/articles/csf-like-parenchymal-lesions_24559f7a-ed5a-4ab6-90ba-769f0b5c1197.md",
|
||||||
|
"81d0b69c9d00fa582a4a992b721b01930ecd1611e7aa0dcf91049eb752ee3e22": "docs_md/external/https-appstatdxcom-document-content-24559f7a-ed5a-4ab6-90ba-769f0b5c1197_app.statdx.com_document_content_24559f7a-ed5a-4ab6-90ba-769f0b5c1197_0b5c5cd9_20251014T195936Z.meta.md",
|
||||||
|
"b215beb1d68b7c0b92309ace2e43e00b8dd77ae5210634a95282f19c9d123855": "docs_md/articles/normal-aging-brain_2a315550-b2ea-4afe-a2ef-f93a2209f276.md",
|
||||||
|
"c51f31c8c91f8341d3ae0703fbf3bdf6b2f316d3efff0f4a61bee2a5aee525a7": "docs_md/external/https-appstatdxcom-document-content-2a315550-b2ea-4afe-a2ef-f93a2209f276_app.statdx.com_document_content_2a315550-b2ea-4afe-a2ef-f93a2209f276_6955e903_20251014T204549Z.meta.md",
|
||||||
|
"43b33e02a14c9f3b70f2fb1d92a45a406538806704d644428f8da00e37b3b312": "docs_md/articles/alzheimer-disease_2aad3ac4-44fd-43e5-8e50-a86987483af3.md",
|
||||||
|
"7d682ac0983afdfffaa2fb4d2d47c1824b2992df52eebed2cae6f2a5a1d1517a": "docs_md/external/https-appstatdxcom-document-content-2aad3ac4-44fd-43e5-8e50-a86987483af3_app.statdx.com_document_content_2aad3ac4-44fd-43e5-8e50-a86987483af3_430ffae3_20251014T193414Z.meta.md",
|
||||||
|
"8d0d986e6b608b6afd02c3892aaf9127d8425450c7c95e6575878342247cdd52": "docs_md/articles/parkinsonian-syndromes_2b99b31a-ec1a-4dce-bb63-2a101fe9f044.md",
|
||||||
|
"d3cf45ff401705f94cd7d2b928c484681a7772a35b0534f531ecdf47cceaeb80": "docs_md/external/https-appstatdxcom-document-content-2b99b31a-ec1a-4dce-bb63-2a101fe9f044_app.statdx.com_document_content_2b99b31a-ec1a-4dce-bb63-2a101fe9f044_dc973ded_20251014T193525Z.meta.md",
|
||||||
|
"987e2ddc170b19041c457797cd55da626bada0603d899a5c3ca419afd597b813": "docs_md/articles/multiinfarct-dementia_3823c4d4-5e98-46da-a717-892fef54b382.md",
|
||||||
|
"f1cfbeb100ec82283e429185bc5506685033b421b72efeb9c0795b85f85c4001": "docs_md/external/https-appstatdxcom-document-content-3823c4d4-5e98-46da-a717-892fef54b382_app.statdx.com_document_content_3823c4d4-5e98-46da-a717-892fef54b382_68f10467_20251014T185335Z.meta.md",
|
||||||
|
"bb46c2dd5375afe6a748b59b2050a326fc85778e2427c9c3e6c7999230e74cf8": "docs_md/articles/empty-sella_39a0d2d1-1439-4558-8f5d-86a2a6d93e3a.md",
|
||||||
|
"237051a26c6d3b2d7f5e28554066b041880234080bbcb982114f1eb8d76354fc": "docs_md/external/https-appstatdxcom-document-content-39a0d2d1-1439-4558-8f5d-86a2a6d93e3a_app.statdx.com_document_content_39a0d2d1-1439-4558-8f5d-86a2a6d93e3a_a6956072_20251014T204947Z.meta.md",
|
||||||
|
"3dc97a3d7cf72ddaba23b5d7565487dbf99e9074550594b07929797afcd912a3": "docs_md/articles/fragile-x-associated-tremor-ataxia-fxtas_4778fafe-9873-4c28-8f4f-299c00c72b50.md",
|
||||||
|
"bfe782cb38462deca0ce3abb8163a2f838190e6a710d4e4d7d20f718e499988b": "docs_md/external/https-appstatdxcom-document-content-4778fafe-9873-4c28-8f4f-299c00c72b50_app.statdx.com_document_content_4778fafe-9873-4c28-8f4f-299c00c72b50_07ed0854_20251014T204705Z.meta.md",
|
||||||
|
"d71409edc61ca994e3c107a3313e2019e5f5aea83bf722657766b24d231819a1": "docs_md/articles/frontotemporal-lobar-degeneration_49510d0e-acf7-45cb-9eb1-53f8193b0b6d.md",
|
||||||
|
"3167df8bcd04bb2dae9f46e34ca21351080b076713d1bf930c4db6e208509e50": "docs_md/external/https-appstatdxcom-document-content-49510d0e-acf7-45cb-9eb1-53f8193b0b6d_app.statdx.com_document_content_49510d0e-acf7-45cb-9eb1-53f8193b0b6d_364eb97f_20251014T193509Z.meta.md",
|
||||||
|
"4d0a5dece865b5a5239b5e10098d22b24c8d92b4beaf178a7b2c925d57a56129": "docs_md/articles/adrenal-myelolipoma_5813a554-06a4-4696-af71-7ce50693039d.md",
|
||||||
|
"e7e446865027f72f4aef0fdb11213f807c58a875703dfa03a234aadd99e7c998": "docs_md/external/https-appstatdxcom-document-content-5813a554-06a4-4696-af71-7ce50693039d_app.statdx.com_document_content_5813a554-06a4-4696-af71-7ce50693039d_83b20d1e_20251017T212346Z.meta.md",
|
||||||
|
"3b4cc19ff41d84c202fcb6a327198497e6a5bc392b928933bf375acacb5d4fa9": "docs_md/articles/primary-progressive-aphasia_5dca11fe-b5ee-404c-b22e-4008b7571844.md",
|
||||||
|
"96820c46f137231086b71ee6df91f50ee24ed0ece5c2f0f076670b3466689e60": "docs_md/external/https-appstatdxcom-document-content-5dca11fe-b5ee-404c-b22e-4008b7571844_app.statdx.com_document_content_5dca11fe-b5ee-404c-b22e-4008b7571844_3b5d482e_20251014T193517Z.meta.md",
|
||||||
|
"3db04de725b13e7671b0b964179a612e2b1a0d8e86c498b21cf2c39087f834bd": "docs_md/articles/cyst-with-nodule_6cb71737-f574-4121-a8fb-02eeada9f9f7.md",
|
||||||
|
"54a859320782ca42eac0fa3dcf55935b660b9130ffa8f853c134c1700e59544b": "docs_md/external/https-appstatdxcom-document-content-6cb71737-f574-4121-a8fb-02eeada9f9f7_app.statdx.com_document_content_6cb71737-f574-4121-a8fb-02eeada9f9f7_47a28ee9_20251014T195847Z.meta.md",
|
||||||
|
"4e8c6502b0c28a8c57467aa7c729b45590b1ddda0d6a7ddd99f6a2f3d4f89094": "docs_md/articles/hypertrophic-olivary-degeneration_78257543-6d52-4879-84b1-445f3611d996.md",
|
||||||
|
"79049cd6b95768c6df548f3874fe37e252e7c685f22829582b8cf5ccbff2134b": "docs_md/external/https-appstatdxcom-document-content-78257543-6d52-4879-84b1-445f3611d996_app.statdx.com_document_content_78257543-6d52-4879-84b1-445f3611d996_2670b622_20251014T204719Z.meta.md",
|
||||||
|
"3da7367704165834fe003b5a0556ac4c8a7eb7133cf2098dfa29686c98cab4b2": "docs_md/articles/brain-tumor-in-child-1-year_7d64f5fb-c62c-4861-8ff4-654a12074605.md",
|
||||||
|
"920821e8878c4e6d862742da5013227bfaa78def85f30c33abef5ecd7550584e": "docs_md/external/https-appstatdxcom-document-content-7d64f5fb-c62c-4861-8ff4-654a12074605_app.statdx.com_document_content_7d64f5fb-c62c-4861-8ff4-654a12074605_55889b6f_20251014T200552Z.meta.md",
|
||||||
|
"36f102948b48a74527454d6aee7c0411ff65721ff62d54c1cd2cfc0c3a695d9b": "docs_md/articles/hypothalamic-hamartoma_7f85487f-9497-44a9-b884-b98e50d41018.md",
|
||||||
|
"1b030bfd5edcfb959ee76ef3da96d0d5cc759ef1d87b304ed66029fd9bb6a09e": "docs_md/external/https-appstatdxcom-document-content-7f85487f-9497-44a9-b884-b98e50d41018_app.statdx.com_document_content_7f85487f-9497-44a9-b884-b98e50d41018_a7972d2d_20251014T204850Z.meta.md",
|
||||||
|
"9e712c0cfe3ecda560cf69fb7b3a993c36ee9c6787b963941eaf5410c6214958": "docs_md/articles/normal-pressure-hydrocephalus_834ccc3e-2116-4295-8408-0ac9a06bd2ff.md",
|
||||||
|
"5b38b4481f5cc5db9164d0ea3d67543fc2c52224ba3d953605e847e60dc83924": "docs_md/external/https-appstatdxcom-document-content-834ccc3e-2116-4295-8408-0ac9a06bd2ff_app.statdx.com_document_content_834ccc3e-2116-4295-8408-0ac9a06bd2ff_2e001e66_20251014T193450Z.meta.md",
|
||||||
|
"12b6e0b330f32131f5f3f0d4c2548e45247c2c0b24cc9d3b126e78ed0dd655d9": "docs_md/articles/progressive-supranuclear-palsy_840ed321-c0ab-4069-a07e-ad416232f916.md",
|
||||||
|
"56d98a595a67960a1f5540ef057a506138ded9c559f132369cf5a3ac04c0f0b1": "docs_md/external/https-appstatdxcom-document-content-840ed321-c0ab-4069-a07e-ad416232f916_app.statdx.com_document_content_840ed321-c0ab-4069-a07e-ad416232f916_254e1757_20251014T204728Z.meta.md",
|
||||||
|
"1a7e20dd9ec7d90e75b1bb12c5cde610518faa1228152f4c0d6f17eff8ff7da4": "docs_md/articles/solitary-cystic-parenchymal-mass-general_8bfa943b-c158-4a3b-9d43-e6ef057f45d4.md",
|
||||||
|
"544f72bc3fd6897035ea0b09c5615b128a707615a31599127fac2d5fecfc3748": "docs_md/external/https-appstatdxcom-document-content-8bfa943b-c158-4a3b-9d43-e6ef057f45d4_app.statdx.com_document_content_8bfa943b-c158-4a3b-9d43-e6ef057f45d4_377dc90d_20251014T204445Z.meta.md",
|
||||||
|
"843d8ce3d6e5ffeb675a307dac794f66cd0a838c622f45ac867f520986577c0d": "docs_md/articles/neurodegeneration-with-brain-iron-accumulation-nbia_8e3465d1-d058-48d8-863c-1fd85cc6caee.md",
|
||||||
|
"fb7a00879f3bac38cbc841c3eb593fcb08500b0a4a1719f1118094dbfb54a830": "docs_md/external/https-appstatdxcom-document-content-8e3465d1-d058-48d8-863c-1fd85cc6caee_app.statdx.com_document_content_8e3465d1-d058-48d8-863c-1fd85cc6caee_14a615d6_20251014T204533Z.meta.md",
|
||||||
|
"c6bd32a15b4f59e8fad4e9feff4056b1e8ea5a3b6830c6cad0966a2fe99aa939": "docs_md/articles/rathke-cleft-cyst_8f1561f7-92a7-485c-a0ae-2e2d5c8c1628.md",
|
||||||
|
"381f113c0c468347066f6b10ba9f876f3429bfd7fc71430b1851106421714db8": "docs_md/external/https-appstatdxcom-document-content-8f1561f7-92a7-485c-a0ae-2e2d5c8c1628_app.statdx.com_document_content_8f1561f7-92a7-485c-a0ae-2e2d5c8c1628_f8845a9c_20251014T204923Z.meta.md",
|
||||||
|
"7e32629a3a5f04e77c3c70c7f8354bc91e99f516d6d1eb00acde3979fd8d3973": "docs_md/articles/pituitary-hyperplasia_9696bc9e-f00b-4fa7-aa67-f039efd8fbed.md",
|
||||||
|
"cd884013efd0f5cca0f44a1cdedacefc3ec00b42f22070453729760193e19376": "docs_md/external/https-appstatdxcom-document-content-9696bc9e-f00b-4fa7-aa67-f039efd8fbed_app.statdx.com_document_content_9696bc9e-f00b-4fa7-aa67-f039efd8fbed_8805ff5a_20251014T205140Z.meta.md",
|
||||||
|
"ca7df50d8ed5af7ca3be105ccf73f24a4d26817b378fae1871e3eae5a0827ffb": "docs_md/articles/frontotemporal-dementia_9f9eda8c-7e3c-4292-9861-4b8abc2c6474.md",
|
||||||
|
"2bcd626928260fdd931f3877bda4307d59015517bbca1bc72765d592107deef2": "docs_md/external/https-appstatdxcom-document-content-9f9eda8c-7e3c-4292-9861-4b8abc2c6474_app.statdx.com_document_content_9f9eda8c-7e3c-4292-9861-4b8abc2c6474_2dde52e4_20251014T185357Z.meta.md",
|
||||||
|
"1f56ba43275d457af490b6ade459a8b45638a68c7756ef6a39ac650de8e0301d": "docs_md/articles/attention-control-network_a1bedda5-6478-40b2-98e7-6c5f5363b06f.md",
|
||||||
|
"7e65a279ef25c534bfcee49415e3476f6828a24b163f94c9f04b92fa1cb6a733": "docs_md/external/https-appstatdxcom-document-content-a1bedda5-6478-40b2-98e7-6c5f5363b06f_app.statdx.com_document_content_a1bedda5-6478-40b2-98e7-6c5f5363b06f_068cbfb3_20251014T185127Z.meta.md",
|
||||||
|
"32fff07a347799f5143b7decd56cab2256d1e86aa475258469407a5b10852deb": "docs_md/articles/epilepsy-child_a342e5b5-5b98-4003-a437-6d42a483b40e.md",
|
||||||
|
"d46a8bf3e5da6860e331a56de27852970466cf7cfe9823a4af47c985755e2e5f": "docs_md/external/https-appstatdxcom-document-content-a342e5b5-5b98-4003-a437-6d42a483b40e_app.statdx.com_document_content_a342e5b5-5b98-4003-a437-6d42a483b40e_939c8569_20251014T204358Z.meta.md",
|
||||||
|
"d2fcf019f5973764e6c3f2f8ba848d56efb2253d2007aa8695c59ae0d9880402": "docs_md/articles/pkan_aa473236-a733-4f9b-8d92-267ab8d4bcd9.md",
|
||||||
|
"13e4edd55e99a2183f16649f2426d4b80c082a0a05430f3dfab53dea97dbe766": "docs_md/external/https-appstatdxcom-document-content-aa473236-a733-4f9b-8d92-267ab8d4bcd9_app.statdx.com_document_content_aa473236-a733-4f9b-8d92-267ab8d4bcd9_f344beea_20251014T204510Z.meta.md",
|
||||||
|
"9dc070ceacdcbd53c5a41da046f438cdd8e6e76bc608821afe5599f2ed090375": "docs_md/articles/crossed-cerebellar-diaschisis_c1e384b3-3c6e-4f67-bf79-5187bd6a1b86.md",
|
||||||
|
"4f6c975ff6e60238c482e989b73121b679f2f2c9243b45f9ab806cd5e5b0092b": "docs_md/external/https-appstatdxcom-document-content-c1e384b3-3c6e-4f67-bf79-5187bd6a1b86_app.statdx.com_document_content_c1e384b3-3c6e-4f67-bf79-5187bd6a1b86_74517038_20251014T204643Z.meta.md",
|
||||||
|
"433a086e59f60bb3610b0448ba6b34e61baa4828b946b1a410fe2a7258f6d0e1": "docs_md/articles/adrenal-cyst_c5d717a3-3d6e-4e86-9efe-1ad0ec14740f.md",
|
||||||
|
"a190df3a8ed59c2edc942ad7c9155c712180686efc4bb82423cae85df86b2cce": "docs_md/external/https-appstatdxcom-document-content-c5d717a3-3d6e-4e86-9efe-1ad0ec14740f_app.statdx.com_document_content_c5d717a3-3d6e-4e86-9efe-1ad0ec14740f_1172170b_20251017T212337Z.meta.md",
|
||||||
|
"82056b9e81ac92096c445680426e5c125b2cc2afbc749e7dca94986ea05a2433": "docs_md/articles/epilepsy-adult_c936f9e1-b6c6-4c4a-afc6-f2e1a968a7b0.md",
|
||||||
|
"b6dea1bee258dc90ddc4915e01e2422aa33f24598c16769c58b05380dccbadab": "docs_md/external/https-appstatdxcom-document-content-c936f9e1-b6c6-4c4a-afc6-f2e1a968a7b0_app.statdx.com_document_content_c936f9e1-b6c6-4c4a-afc6-f2e1a968a7b0_6ab4623e_20251014T204348Z.meta.md",
|
||||||
|
"26a6ce4b6e174212cea3f4de4f601f6bea2735b3cca53dc236242d1d014a0a24": "docs_md/articles/granular-cell-tumor_da976b04-85a3-4bf8-ac81-e579f081293e.md",
|
||||||
|
"491eb47d85e2ad071dccbfee1649f9c6d0b9a8e24bd9a81fb382dd9239543b6d": "docs_md/external/https-appstatdxcom-document-content-da976b04-85a3-4bf8-ac81-e579f081293e_app.statdx.com_document_content_da976b04-85a3-4bf8-ac81-e579f081293e_c381b3d7_20251014T205304Z.meta.md",
|
||||||
|
"93cf9b0021c0ddc71335a193d408536e94baa6ac8f09d50024a42baf650dfd9e": "docs_md/articles/spinocerbellar-ataxia_df64565a-5c8c-4387-879b-b341b655e478.md",
|
||||||
|
"540d680d534cc0998e086b6f629b91a2dadcae74c3a422476f8a7715ca79ed4a": "docs_md/external/https-appstatdxcom-document-content-df64565a-5c8c-4387-879b-b341b655e478_app.statdx.com_document_content_df64565a-5c8c-4387-879b-b341b655e478_2178f1d4_20251014T204610Z.meta.md",
|
||||||
|
"8855f0e94f69fff63493debf9b905180696299b57166957f5b55660555587d1c": "docs_md/articles/creutzfeldt-jakob-disease-cjd_e1b27954-6591-4bb0-a659-b13790492620.md",
|
||||||
|
"745e41378795a828444ed93b1f6874187dda9eff670941f0032e7789bf3a1bf2": "docs_md/external/https-appstatdxcom-document-content-e1b27954-6591-4bb0-a659-b13790492620_app.statdx.com_document_content_e1b27954-6591-4bb0-a659-b13790492620_22d67a60_20251014T204650Z.meta.md",
|
||||||
|
"49ff1dc0241d5f6f854ddd53394e6bb830c4f3b05f6c3c317f4acb83fe668dcd": "docs_md/articles/adrenal-adenoma_e2916d86-5f9f-4dd3-9576-1a7b89d8dda0.md",
|
||||||
|
"18a9b5738b4e9977e65b9473ae7e2b48603a9680c8132a46e48cb2abc7d9d42b": "docs_md/external/https-appstatdxcom-document-content-e2916d86-5f9f-4dd3-9576-1a7b89d8dda0_app.statdx.com_document_content_e2916d86-5f9f-4dd3-9576-1a7b89d8dda0_553d0dda_20251017T212330Z.meta.md",
|
||||||
|
"573773d132fe5d3d5ff6655f15ee5f3d69d73a858abbc41f27f8983ccfd766c8": "docs_md/articles/wallerian-degeneration_e4bb682d-6534-4176-9d39-34c1a42f3771.md",
|
||||||
|
"749c70c544da5afbca891b1ebf31603f7b230bd64ad29a870d339afab9708ec3": "docs_md/external/https-appstatdxcom-document-content-e4bb682d-6534-4176-9d39-34c1a42f3771_app.statdx.com_document_content_e4bb682d-6534-4176-9d39-34c1a42f3771_ded98aae_20251014T204626Z.meta.md",
|
||||||
|
"88d035bc3265b6478d0e2bd4b2d421e0313ace59b941927ce9d4201381165ac4": "docs_md/articles/dementia-with-lewy-bodies_e8e46d1d-46d2-4e5a-880f-f025a84c5871.md",
|
||||||
|
"a7f5724c8e1f4a657212b317c2d801b3112b2be3515c246ad7c1754ddf3b227d": "docs_md/external/https-appstatdxcom-document-content-e8e46d1d-46d2-4e5a-880f-f025a84c5871_app.statdx.com_document_content_e8e46d1d-46d2-4e5a-880f-f025a84c5871_01610362_20251014T193405Z.meta.md",
|
||||||
|
"412dd21efc8e036a5d93b713f557f36ff8f13a0a3e0f71a21f65258b00e2f689": "docs_md/articles/lymphocytic-hypophysitis_f30774c3-cbd0-4ab3-b3d1-e0574106db1f.md",
|
||||||
|
"f079a3fb2928243685d408e16b599a7998701c23d969223e4eedaeee6d20e77c": "docs_md/external/https-appstatdxcom-document-content-f30774c3-cbd0-4ab3-b3d1-e0574106db1f_app.statdx.com_document_content_f30774c3-cbd0-4ab3-b3d1-e0574106db1f_63615b1f_20251014T204954Z.meta.md",
|
||||||
|
"a909f462bee40a74aeaa8456f8ab1d4d87f6c4efb08a64253e909f85bc93fa8b": "docs_md/articles/vascular-dementia_f59dab57-c511-4369-8fcc-592421a4b8d1.md",
|
||||||
|
"560f9312f26896ee62881d086ed5cfa74ca41ec027e4e13a60a5b56ec5a5f182": "docs_md/external/https-appstatdxcom-document-content-f59dab57-c511-4369-8fcc-592421a4b8d1_app.statdx.com_document_content_f59dab57-c511-4369-8fcc-592421a4b8d1_05e6592c_20251014T185346Z.meta.md",
|
||||||
|
"e241f3c3a865486be3d53d872fcc526b52fe608e4ef4ce0f0a6d83b55f1d91b6": "docs_md/articles/lewy-body-dementia_f6a4382b-f0f7-4582-a703-7f695c65656f.md",
|
||||||
|
"f9047d3410af409df29a434c7a4e59c45428024ca211df6425c5aecb6bec98ee": "docs_md/external/https-appstatdxcom-document-content-f6a4382b-f0f7-4582-a703-7f695c65656f_app.statdx.com_document_content_f6a4382b-f0f7-4582-a703-7f695c65656f_17f89880_20251014T185404Z.meta.md",
|
||||||
|
"669126848cfb0dda10d8613b56e46ce1adf045fdf906d8264c4ae1a28e655636": "docs_md/articles/alzheimer-disease_f71f5cf5-b1af-4c6d-b145-b4c10eec7b58.md",
|
||||||
|
"9c6c289a9518e5a3ddcab29c00d6704b3c4865e89c030fbc9455050a60f1dbba": "docs_md/external/https-appstatdxcom-document-content-f71f5cf5-b1af-4c6d-b145-b4c10eec7b58_app.statdx.com_document_content_f71f5cf5-b1af-4c6d-b145-b4c10eec7b58_3bf23d8b_20251014T193423Z.meta.md",
|
||||||
|
"c7702914a2b5b37501f471289a9787c72403bacd557fcd1519fba54c3faf26ce": "docs_md/external/https-appstatdxcom-document-csf-like-parenchymal-lesions-24559f7a-ed5a-4ab6-90ba_app.statdx.com_document_csf-like-parenchymal-lesions_24559f7a-ed5a-4ab6-90ba-769f0b5c1197_f7d84241_20251014T200033Z.meta.md",
|
||||||
|
"2e8e0273208aae11c09794f79ef0d283ec314a09532d5879c38a3488adb648d0": "docs_md/external/https-appstatdxcom-document-da976b04-85a3-4bf8-ac81-e579f081293e-media_app.statdx.com_document_da976b04-85a3-4bf8-ac81-e579f081293e_media_642ff061_20251014T205303Z.meta.md",
|
||||||
|
"3fd13afe72616012e9b8f3cadcaa171314862a8c188e01e71b6d95ccd30afa53": "docs_md/external/https-appstatdxcom-document-e1b27954-6591-4bb0-a659-b13790492620-media_app.statdx.com_document_e1b27954-6591-4bb0-a659-b13790492620_media_203f5935_20251014T204650Z.meta.md",
|
||||||
|
"7ac23e0c647137a63b89759d7da1b34bfa43bb8d6b4271e8b58acfa3a115ccd1": "docs_md/external/https-appstatdxcom-document-e1b27954-6591-4bb0-a659-b13790492620-tables_app.statdx.com_document_e1b27954-6591-4bb0-a659-b13790492620_tables_817c9ec4_20251014T193440Z.meta.md",
|
||||||
|
"42610ac4e00ef45311e9aceafa9a2844ce8a01abbf93da88bca2734cf450a632": "docs_md/external/https-appstatdxcom-document-e2916d86-5f9f-4dd3-9576-1a7b89d8dda0-media_app.statdx.com_document_e2916d86-5f9f-4dd3-9576-1a7b89d8dda0_media_b0ad9ef2_20251017T212537Z.meta.md",
|
||||||
|
"955be7b0036216e66dd365a24355d349181298e119abfa48b75ec8388034907b": "docs_md/external/https-appstatdxcom-document-e2916d86-5f9f-4dd3-9576-1a7b89d8dda0-tables_app.statdx.com_document_e2916d86-5f9f-4dd3-9576-1a7b89d8dda0_tables_6a891e54_20251017T212537Z.meta.md",
|
||||||
|
"3a57091748bce8df43af1073fb6d1d5379a8ecdd0583e5ac204f8739d916d74d": "docs_md/external/https-appstatdxcom-document-e4bb682d-6534-4176-9d39-34c1a42f3771-media_app.statdx.com_document_e4bb682d-6534-4176-9d39-34c1a42f3771_media_51992643_20251014T204626Z.meta.md",
|
||||||
|
"7cdf1b931490a1b19d9940e6f57aa6d6d061ef59ff9725ac2129e5f507dff7fe": "docs_md/external/https-appstatdxcom-document-e8e46d1d-46d2-4e5a-880f-f025a84c5871-media_app.statdx.com_document_e8e46d1d-46d2-4e5a-880f-f025a84c5871_media_541fbd43_20251014T193405Z.meta.md",
|
||||||
|
"540f41ed78a5eff7166591fc50b09706f55673335b50ea93afdd60c3b2bcb9fc": "docs_md/external/https-appstatdxcom-document-f30774c3-cbd0-4ab3-b3d1-e0574106db1f-media_app.statdx.com_document_f30774c3-cbd0-4ab3-b3d1-e0574106db1f_media_616f3ce9_20251014T204954Z.meta.md",
|
||||||
|
"abcb5346f4a53edbc5649bc8d49b6c37b7adf7000fbfc4ced8bff2e0b607de5c": "docs_md/external/https-appstatdxcom-document-f59dab57-c511-4369-8fcc-592421a4b8d1-media_app.statdx.com_document_f59dab57-c511-4369-8fcc-592421a4b8d1_media_0f9fed25_20251014T204618Z.meta.md",
|
||||||
|
"a390c974122d032d8a580f277e9719d56175d429ba079827d78c6d567823c759": "docs_md/external/https-appstatdxcom-document-f71f5cf5-b1af-4c6d-b145-b4c10eec7b58-media_app.statdx.com_document_f71f5cf5-b1af-4c6d-b145-b4c10eec7b58_media_c350e39c_20251014T193422Z.meta.md",
|
||||||
|
"5c3bf156bfd2f9e4b7bf01ee5fd72b6f9fd21ab1960a3301297f9ad68a5173cb": "docs_md/external/https-appstatdxcom-main_app.statdx.com_main_00e71309_20251017T212307Z.meta.md",
|
||||||
|
"aefa196a21aedc8854a27dc293031b83828d7e355b0647527d923304c97e3a33": "docs_md/external/https-appstatdxcom-timetracking-start-csf-like20parenchymal20lesions-brain-ddx_app.statdx.com_timetracking_start_CSF-Like_20Parenchymal_20Lesion_s__Brain_DDX_e3812c4f_20251014T200033Z.meta.md",
|
||||||
|
"0493eeae819b99984603e64f4fa23031f5d37b10e5be95c268605624668b8d50": "docs_md/external/https-appstatdxcom-tree-brain-6d8829f1-14d7-45af-8675-255189aa526a_app.statdx.com_tree_brain_6d8829f1-14d7-45af-8675-255189aa526a_179a579f_20251014T204842Z.meta.md",
|
||||||
|
"efec45ee8dc4278fbe64ab80f93dcc4fe377fe844171367e892969cf9946232d": "docs_md/external/https-appstatdxcom-tree-genitourinary-bd0eb4fe-d465-4faa-a3b7-526e8f01802d_app.statdx.com_tree_genitourinary_bd0eb4fe-d465-4faa-a3b7-526e8f01802d_13437510_20251017T212316Z.meta.md"
|
||||||
|
}
|
||||||
@@ -0,0 +1,334 @@
|
|||||||
|
---
|
||||||
|
title: "Adrenal Adenoma"
|
||||||
|
docid: "e2916d86-5f9f-4dd3-9576-1a7b89d8dda0"
|
||||||
|
breadcrumbs:
|
||||||
|
- "Genitourinary"
|
||||||
|
- "Diagnosis"
|
||||||
|
- "Adrenal"
|
||||||
|
- "Benign Neoplasms"
|
||||||
|
- "Adrenal Adenoma"
|
||||||
|
---
|
||||||
|
# KEY FACTS
|
||||||
|
|
||||||
|
- ## Imaging
|
||||||
|
|
||||||
|
|
||||||
|
- Well-circumscribed, uniform, low-attenuation, small adrenal mass
|
||||||
|
- Low attenuation due to abundant intracytoplasmic lipid
|
||||||
|
- Imaging features of typical lipid-rich adenomas
|
||||||
|
- NECT: < 10 HU (71% sensitivity, 98% specificity)
|
||||||
|
- MR: Significant decrease in signal on out-of-phase T1WI due to intravoxel lipid and water
|
||||||
|
- May show focal areas of heterogeneous attenuation or absence of signal loss due to degeneration, hemorrhage, and fibrin deposition
|
||||||
|
- Clinical context key to differentiate from collision tumor: Unlikely in absence of extraadrenal malignancy
|
||||||
|
- Lipid-poor adenomas (10-40% cases): Utilize relative or absolute CT contrast washout kinetics for diagnosis
|
||||||
|
- Accounts for vast majority of adrenal "incidentalomas"
|
||||||
|
- Imaging intensive algorithm suggested for incidental adrenal lesions, though overwhelming majority are benign and hormonally inactive
|
||||||
|
- Primary hyperaldosteronism (Conn syndrome): 80% due to unilateral, typically small (< 2 cm) adenoma
|
||||||
|
- Cushing syndrome: 80-85% due to adrenal hyperplasia
|
||||||
|
- Typically shows FDG uptake < that of liver on PET/CT
|
||||||
|
- ## Top Differential Diagnoses
|
||||||
|
|
||||||
|
|
||||||
|
- Adrenal metastases and lymphoma
|
||||||
|
- Adrenal (macronodular) hyperplasia
|
||||||
|
- Pheochromocytoma
|
||||||
|
- Adrenal carcinoma
|
||||||
|
- Adrenal myelolipoma
|
||||||
|
- Gastric diverticulum
|
||||||
|
- Adrenal cyst
|
||||||
|
- ## Diagnostic Checklist
|
||||||
|
|
||||||
|
|
||||||
|
- Asymptomatic mass: Usually nonfunctioning adenoma, even in patients with known cancer
|
||||||
|
- NECT and MR are equally accurate for diagnosis of lipid-rich adenoma
|
||||||
|
- Utilize dedicated CECT adrenal protocol with 15-minute delayed imaging for diagnosis of potential lipid-poor adenomas
|
||||||
|
|
||||||
|
# TERMINOLOGY
|
||||||
|
|
||||||
|
- ## Definitions
|
||||||
|
|
||||||
|
|
||||||
|
- Benign adrenal cortical tumor
|
||||||
|
|
||||||
|
# IMAGING
|
||||||
|
|
||||||
|
- ## General Features
|
||||||
|
|
||||||
|
|
||||||
|
- ### Best diagnostic clue
|
||||||
|
|
||||||
|
|
||||||
|
- Imaging strategies target typical adenoma histology: Abundant intracytoplasmic lipid
|
||||||
|
- Low attenuation (< 10 HU) on NECT
|
||||||
|
- Significant loss of signal on out-of-phase T1WI MR (intravoxel fat and water)
|
||||||
|
- ### Size
|
||||||
|
|
||||||
|
|
||||||
|
- Cushing syndrome adenoma: 2-5 cm
|
||||||
|
- Conn syndrome adenoma: Classically < 2 cm (20% < 1 cm)
|
||||||
|
- Vast majority of incidental, hormonally inactive adrenal adenomas are small (< 2 cm)
|
||||||
|
- ### Morphology
|
||||||
|
|
||||||
|
|
||||||
|
- Usually round to oval suprarenal mass
|
||||||
|
- Key concepts
|
||||||
|
- Most common adrenal cortex tumor (10% bilateral)
|
||||||
|
- Accounts for > 90% of all "incidentalomas"
|
||||||
|
- May occur in up to 9% of general population, diagnosed on 5% of CT exams with various indications
|
||||||
|
- Lipid-rich adrenal adenoma: 60-90% of adenomas
|
||||||
|
- Lipid-poor adrenal adenoma: 10-40% of adenomas
|
||||||
|
- Increased incidence in patients with diabetes and hypertension
|
||||||
|
- NECT (or chemical shift MR): Study of choice to diagnose incidental adrenal masses
|
||||||
|
- Classified into 2 types based on function
|
||||||
|
- Nonhyperfunctioning: Normal hormone levels
|
||||||
|
- Hyperfunctioning: Primary hyperaldosteronism, Cushing syndrome, hyperandrogenism
|
||||||
|
- **Cushing syndrome**
|
||||||
|
- 15-25% of cases are due to autonomous adrenal adenoma
|
||||||
|
- 80-85% of cases are due to**adrenal hyperplasia**
|
||||||
|
- Adenomas usually > 2 cm
|
||||||
|
- **Primary hyperaldosteronism (Conn syndrome)**
|
||||||
|
- 80% of cases are due to****adrenal adenoma
|
||||||
|
- 20% of cases are due to adrenal hyperplasia
|
||||||
|
- Adenomas are often small (< 2 cm)
|
||||||
|
- ## CT Findings
|
||||||
|
|
||||||
|
|
||||||
|
- ### NECT
|
||||||
|
|
||||||
|
|
||||||
|
- Smooth, well defined, round or oval in shape
|
||||||
|
- Homogeneous soft tissue mass of 0-20 HU
|
||||||
|
- **Lipid-rich adrenal adenoma** (60-90% of cases)
|
||||||
|
- Uniform low attenuation
|
||||||
|
- Metaanalysis of < 10 HU threshold: 71% sensitivity, 98% specificity
|
||||||
|
- Sensitivity may increase to almost 90% with histogram analysis (identify negative pixels), though variable results and scanner dependent
|
||||||
|
- **Lipid-poor adrenal adenoma** (10-40% of cases)
|
||||||
|
- Attenuation varies from 10-30 HU
|
||||||
|
- Difficult to differentiate from metastases on NECT
|
||||||
|
- Cushing syndrome due to adrenal adenoma
|
||||||
|
- Remainder of ipsilateral gland and contralateral adrenal gland may be atrophic due to ↓ ACTH levels
|
||||||
|
- ↑ cortisol: Feedback inhibition on pituitary ACTH
|
||||||
|
- ACTH-independent macronodular hyperplasia: Multiple, bilateral, functioning adrenal adenomas
|
||||||
|
- Conn syndrome due to adrenal adenoma
|
||||||
|
- Remainder of ipsilateral gland and contralateral adrenal gland appear normal
|
||||||
|
- Large adenomas
|
||||||
|
- More heterogeneous than small adenomas
|
||||||
|
- ± hemorrhage, cystic degeneration, calcification
|
||||||
|
- Growth should raise suspicion for malignancy
|
||||||
|
- ### CECT
|
||||||
|
|
||||||
|
|
||||||
|
- Enhancing adrenal mass that deenhances rapidly
|
||||||
|
- Dedicated adrenal CT exam incorporates initial dynamic enhanced phase (~ 70-second delay) and 15-minute delay
|
||||||
|
- Relative percentage washout = dynamic enhanced (HU) - delayed (HU) / dynamic enhanced HU
|
||||||
|
- Relative percentage washout > 40%: 96% sensitivity, 100% specificity
|
||||||
|
- Absolute percentage washout (if NECT available) = dynamic enhanced (HU) - delayed (HU) / dynamic enhanced (HU) - unenhanced (HU)
|
||||||
|
- Absolute percentage washout > 60%: 86-88% sensitivity, 92-96% specificity
|
||||||
|
- 10-minute delay utilized by some centers, but shorter delay may decrease sensitivity
|
||||||
|
- Adrenal washout calculators readily available online
|
||||||
|
- Utilize technique for indeterminate, potentially lipid-poor adenomas
|
||||||
|
- Clinical context critical: Rapid washout can be seen with pheochromocytomas, renal cell, hepatocellular carcinoma, and hypervascular metastases
|
||||||
|
- Dual-energy CT and iodine subtraction techniques can generate virtual noncontrast (VNC) images
|
||||||
|
- May identify lipid-rich adenomas and obviate need for additional imaging
|
||||||
|
- Iodine:VNC ratio ≥ 6.7 has sensitivity and specificity of 95% for adenoma (higher ratios in adenoma compared to metastasis)
|
||||||
|
- ## MR Findings
|
||||||
|
|
||||||
|
|
||||||
|
- T1WI and T2WI
|
||||||
|
- Low to intermediate signal
|
||||||
|
- Chemical shift (in- and out-of-phase) imaging
|
||||||
|
- Mainstay of MR diagnosis
|
||||||
|
- Sensitivity and specificity equivalent to NECT
|
||||||
|
- Signal loss on out-of-phase T1WI due to intravoxel water and fat protons
|
||||||
|
- Inverse relationship between percentage of lipid-rich cells and relative ↓ signal on out-of-phase imaging
|
||||||
|
- May not identify lipid-poor adenomas
|
||||||
|
- Visual inspection of signal in phase (SIP) and out of phase (SOP), though quantitative analysis may be helpful
|
||||||
|
- Adrenal to spleen chemical shift imaging (CSI) ratio: Lesion:spleen SOP/adrenal/spleen SIP
|
||||||
|
- < .71 = adenoma
|
||||||
|
- Adrenal signal intensity index: 100 x (SIP - SOP) / SIP
|
||||||
|
- > 16.5% = adenoma
|
||||||
|
- Beware technical pitfalls
|
||||||
|
- Sampling of 1st echo pair at 3T is challenging
|
||||||
|
- India ink artifact mimics signal loss, particularly in small adrenal lesions
|
||||||
|
- Other primary or secondary adrenal lesions may contain lipid
|
||||||
|
- Adenomas and metastases may coexist in same gland (collision tumor)
|
||||||
|
- T1 C+ MR
|
||||||
|
- Rapid, uniform enhancement and deenhancement
|
||||||
|
- Ancillary MR techniques
|
||||||
|
- Diffusion MR: Not specific (ADC overlap between adenomas and metastases)
|
||||||
|
- MR spectroscopy: Choline:creatinine and choline:lipid ratio discriminatory threshold ratios may aid in adrenal lesion characterization, though larger studies needed
|
||||||
|
- ## Ultrasonographic Findings
|
||||||
|
|
||||||
|
|
||||||
|
- ### Grayscale ultrasound
|
||||||
|
|
||||||
|
|
||||||
|
- Nonspecific, solid suprarenal mass
|
||||||
|
- Right suprarenal mass seen more clearly left due to acoustic window provided by liver
|
||||||
|
- ## Angiographic Findings
|
||||||
|
|
||||||
|
|
||||||
|
- Conventional
|
||||||
|
- Adrenal arteriography
|
||||||
|
- Catheterization of renal or inferior adrenal arteries shows vascular supply of adrenal tumors
|
||||||
|
- Adenomas are usually hypo- to moderately vascular
|
||||||
|
- No arterial encasement or venous laking or puddling, which are malignant vascular features
|
||||||
|
- Adrenal venography
|
||||||
|
- Most commonly to obtain adrenal vein samples
|
||||||
|
- Advocated for patients with primary hyperaldosteronism triaged to adrenalectomy
|
||||||
|
- Technically difficult study but may confirm laterality of small, aldosterone-secreting adenoma
|
||||||
|
- Technical approach and criteria for positive study varies; ACTH stimulation may increase accuracy
|
||||||
|
- Adrenal adenoma is seen as filling defect within adrenal gland displacing adjacent vessels
|
||||||
|
- Circumferential vein frequently seen around adrenal adenoma
|
||||||
|
- ## Nuclear Medicine Findings
|
||||||
|
|
||||||
|
|
||||||
|
- PET/CT
|
||||||
|
- Utilized as part of malignancy staging
|
||||||
|
- Markedly increased F-18 FDG uptake characteristic of metastases
|
||||||
|
- Adenomas may also accumulate F-18 FDG, typically less intense than liver
|
||||||
|
- Potential false-negatives: Metastases from primary carcinomas that are non-FDG avid (e.g., neuroendocrine tumors)
|
||||||
|
- SUV thresholds published but adenomas typically less intense than liver
|
||||||
|
- Adrenocortical scintigraphy by using NP-59
|
||||||
|
- NP-59 is cholesterol analog that binds to low-density lipoprotein receptors of adrenal cortex
|
||||||
|
- NP-59 used and dexamethasone: Accentuate uptake in non-ACTH-dependent adrenal tissues (adenoma)
|
||||||
|
- Normal NP-59: When both adrenal glands are seen 5 days after injection or thereafter
|
||||||
|
- Adrenal adenoma: Unilateral early adrenal visualization before day 5 after NP-59 injection
|
||||||
|
- Adrenal hyperplasia: Bilateral early adrenal visualization before day 5 after NP-59 injection
|
||||||
|
- ## Imaging Recommendations
|
||||||
|
|
||||||
|
|
||||||
|
- NECT is initial study of choice to confirm diagnosis of lipid-rich adrenal adenoma
|
||||||
|
- ROI should encompass lesion: Attenuation < 10 HU is diagnostic
|
||||||
|
- In- and out-of-phase MR equivalent to NECT for lipid-rich lesions
|
||||||
|
- Signal dropout on out-of-phase T1WI MR: Qualitative assessment typically suffices
|
||||||
|
- CECT, including 15-minute delayed phase, used for potential lipid-poor adenomas: Calculate either relative or absolute washout
|
||||||
|
|
||||||
|
# DIFFERENTIAL DIAGNOSIS
|
||||||
|
|
||||||
|
- [Adrenal Metastases and Lymphoma](/document/adrenal-lymphoma/44639c90-bd04-4e2a-a470-2c28a0e2ff78)
|
||||||
|
- Adrenal metastases
|
||||||
|
- Unilateral or bilateral masses ± central necrosis, hemorrhage
|
||||||
|
- Usually known to have malignancy elsewhere
|
||||||
|
- NECT: Metastases mimic lipid-poor adenoma
|
||||||
|
- CECT: Hypo- or hypervascular and prolonged washout pattern
|
||||||
|
- Adrenal lymphoma
|
||||||
|
- Usually spread to adrenal gland from retroperitoneal tumor
|
||||||
|
- Unilateral or bilateral masses
|
||||||
|
- Unilateral primary lymphoma (non-Hodgkin) can mimic adenoma
|
||||||
|
- Hypovascular; moderate enhancement with contrast
|
||||||
|
- [Adrenal Myelolipoma](/document/adrenal-myelolipoma/5813a554-06a4-4696-af71-7ce50693039d)
|
||||||
|
- Small or large, asymptomatic adrenal mass
|
||||||
|
- Intramural macroscopic fatty elements on imaging
|
||||||
|
- [Adrenal Hyperplasia](/document/adrenal-hyperplasia/90d09395-41d4-49b4-bb1d-4cb00b8bc272)
|
||||||
|
- Adrenal glands are often symmetrically enlarged
|
||||||
|
- Width of adrenal gland limbs > 10 mm (diagnostic)
|
||||||
|
- No discrete mass or nodule seen as rule
|
||||||
|
- Dominant macronodule of macronodular hyperplasia mimics small adrenal adenomas
|
||||||
|
- Cortisol-secreting adenoma: Remainder of ipsilateral and contralateral glands, atrophic (↓ ACTH)
|
||||||
|
- Macronodular hyperplasia: Both glands are enlarged (due to elevated ACTH levels)
|
||||||
|
- No obvious enhancement and washout pattern seen
|
||||||
|
- [Pheochromocytoma](/document/pheochromocytoma/7d3c4062-643c-4030-8783-f85184ad8132)
|
||||||
|
- Tumor > 3 cm in most cases; classically T2 hyperintense
|
||||||
|
- Highly vascular tumor prone to hemorrhage, necrosis
|
||||||
|
- Bilateral adrenal tumors in multiple endocrine neoplasia (MEN) syndromes
|
||||||
|
- [Unilateral Adrenal Hemorrhage](/document/adrenal-hemorrhage/5812e5c4-ca8a-4af5-884b-f75795bcde0f)
|
||||||
|
- Chronic hematoma: Well-defined, round, low-density, mass-like lesion simulating adenoma
|
||||||
|
- [Adrenal Carcinoma](/document/adrenal-cortical-carcinoma/bdc7a08b-a64f-4bd2-9dfc-24331728e85e)
|
||||||
|
- Rare, unilateral, invasive and enhancing mass
|
||||||
|
- > 6 cm when initially diagnosed
|
||||||
|
- [Gastric Diverticulum](/document/gastric-diverticulum/eeb101f0-8bdf-4771-b44a-fe6e73b3a463)
|
||||||
|
- Abnormal, rounded soft tissue lesion in left suprarenal area; mimics adrenal mass
|
||||||
|
- Diverticular contents do not enhance, whereas adenomas do
|
||||||
|
- Distend stomach with gas and fluid; scan in prone position to distend diverticulum
|
||||||
|
- [Ganglioneuroma](/document/pheochromocytoma/7d3c4062-643c-4030-8783-f85184ad8132)
|
||||||
|
- Younger patients; mean age: 27 years
|
||||||
|
- Larger mass; average tumor size: 8 cm
|
||||||
|
- ## Adrenal Cyst
|
||||||
|
|
||||||
|
|
||||||
|
- Attenuation similar to lipid-rich adenoma
|
||||||
|
- Lack of enhancement, rim calcification may suggest diagnosis
|
||||||
|
|
||||||
|
# PATHOLOGY
|
||||||
|
|
||||||
|
- ## General Features
|
||||||
|
|
||||||
|
|
||||||
|
- ### Etiology
|
||||||
|
|
||||||
|
|
||||||
|
- Unknown
|
||||||
|
- ### Associated abnormalities
|
||||||
|
|
||||||
|
|
||||||
|
- MEN syndromes
|
||||||
|
- Most adrenals with adenoma have normal function
|
||||||
|
- Occasionally adenoma causes adrenal hyperfunction
|
||||||
|
- Normal adrenocortical secretory hormones
|
||||||
|
- Cortisol, aldosterone, androgens
|
||||||
|
- ## Gross Pathologic & Surgical Features
|
||||||
|
|
||||||
|
|
||||||
|
- Well-delineated, tan-yellow, ovoid mass
|
||||||
|
- 3 microscopic patterns
|
||||||
|
- Pure (fasciculata- or reticularis-type cells), mixed, or hybrid
|
||||||
|
- May have focal areas of degeneration, hemorrhage, and fibrin deposition
|
||||||
|
- ## Microscopic Features
|
||||||
|
|
||||||
|
|
||||||
|
- 70% of adenomas: High % of intracytoplasmic lipid
|
||||||
|
- 30% of adenomas: Low % of intracytoplasmic lipid
|
||||||
|
|
||||||
|
# CLINICAL ISSUES
|
||||||
|
|
||||||
|
- ## Presentation
|
||||||
|
|
||||||
|
|
||||||
|
- ### Most common signs/symptoms
|
||||||
|
|
||||||
|
|
||||||
|
- Asymptomatic incidental CT finding
|
||||||
|
- Conn syndrome: Hypertension and weakness
|
||||||
|
- Cushing syndrome: Moon facies, truncal obesity, purple striae, and buffalo hump
|
||||||
|
- Virilization in women
|
||||||
|
- Lab data: ↑ aldosterone, cortisol, &/or androgens
|
||||||
|
- Diagnosis: Clinical, biochemical, imaging, histology
|
||||||
|
- ## Demographics
|
||||||
|
|
||||||
|
|
||||||
|
- ### Age
|
||||||
|
|
||||||
|
|
||||||
|
- Prevalence of adenoma increases with age
|
||||||
|
- Peak at 60-69 years, decreasing thereafter
|
||||||
|
- ### Epidemiology
|
||||||
|
|
||||||
|
|
||||||
|
- Most common adrenal tumor of all incidentalomas
|
||||||
|
- ↑ incidence in patients with diabetes or hypertension
|
||||||
|
- Occurs in up to 9% of population (postmortem data)
|
||||||
|
- ## Natural History & Prognosis
|
||||||
|
|
||||||
|
|
||||||
|
- Prognosis: Excellent when incidental and nonhyperfunctioning
|
||||||
|
- ## Treatment
|
||||||
|
|
||||||
|
|
||||||
|
- No treatment when asymptomatic incidental finding
|
||||||
|
- Laparoscopic removal of gland if hyperfunctioning
|
||||||
|
|
||||||
|
# DIAGNOSTIC CHECKLIST
|
||||||
|
|
||||||
|
- ## Consider
|
||||||
|
|
||||||
|
|
||||||
|
- Asymptomatic mass: Usually nonhyperfunctioning adenoma, even in patient with known cancer
|
||||||
|
- ## Image Interpretation Pearls
|
||||||
|
|
||||||
|
|
||||||
|
- Well-defined, low-density (< 10 HU) suprarenal mass
|
||||||
|
- Enhances with washout pattern > 50% within 15 minutes
|
||||||
|
- Out-of-phase T1WI MR: Signal dropout, lipid-rich mass
|
||||||
|
|
||||||
|
adc00b93-b4c7-4e75-91bd-72023f4cd548
|
||||||
@@ -0,0 +1,256 @@
|
|||||||
|
---
|
||||||
|
title: "Adrenal Cyst"
|
||||||
|
docid: "c5d717a3-3d6e-4e86-9efe-1ad0ec14740f"
|
||||||
|
breadcrumbs:
|
||||||
|
- "Genitourinary"
|
||||||
|
- "Diagnosis"
|
||||||
|
- "Adrenal"
|
||||||
|
- "Benign Neoplasms"
|
||||||
|
- "Adrenal Cyst"
|
||||||
|
---
|
||||||
|
# KEY FACTS
|
||||||
|
|
||||||
|
- ## Imaging
|
||||||
|
|
||||||
|
|
||||||
|
- "Adrenal cyst" is descriptive term, not pathological diagnosis
|
||||||
|
- True adrenal cysts
|
||||||
|
- Majority are endothelial cysts (lymphangiomas)
|
||||||
|
- Epithelial cysts exceedingly rare
|
||||||
|
- Simple, or minimally complex, adrenal cyst, thin rim calcification, no enhancement
|
||||||
|
- Pseudocysts
|
||||||
|
- Prior hemorrhage inferred
|
||||||
|
- Nonenhancing but complex contents and wall calcification
|
||||||
|
- Relevant history (extraadrenal malignancy, rapid growth), biochemical evaluation (cortisol, metanephrines): Consider underlying adrenal neoplasm
|
||||||
|
- Enhancing soft tissue components may suggest adrenal mass hemorrhage and pseudocyst formation
|
||||||
|
- Parasitic (echinococcal) cyst
|
||||||
|
- Rare outside endemic areas
|
||||||
|
- Typically in setting of generalized echinococcus
|
||||||
|
- ## Top Differential Diagnoses
|
||||||
|
|
||||||
|
|
||||||
|
- Adrenal adenoma
|
||||||
|
- CECT: Enhancing mass without visible wall or peripheral calcifications
|
||||||
|
- Gastric diverticulum
|
||||||
|
- Air-, fluid-, or contrast-filled mass with no enhancement of contents
|
||||||
|
- Adrenal myelolipoma
|
||||||
|
- Macroscopic fat
|
||||||
|
- Necrotic adrenal tumor
|
||||||
|
- Complex wall with heterogeneous contents
|
||||||
|
- Retroperitoneal bronchogenic cyst
|
||||||
|
- ## Clinical Issues
|
||||||
|
|
||||||
|
|
||||||
|
- No treatment required usually
|
||||||
|
- Imaging surveillance performed, although intensity and length of follow-up not defined
|
||||||
|
- Biochemical evaluation (cortisol, metanephrines) routinely performed to exclude underlying adrenal neoplasm
|
||||||
|
- Surgical resection for complex cyst with enhancing components, or symptomatic cyst
|
||||||
|
- ## Diagnostic Checklist
|
||||||
|
|
||||||
|
|
||||||
|
- Complicated cyst has high attenuation, thick enhancing wall, &/or septations
|
||||||
|
|
||||||
|
# TERMINOLOGY
|
||||||
|
|
||||||
|
- ## Definitions
|
||||||
|
|
||||||
|
|
||||||
|
- "Adrenal cyst" is descriptive term, not pathological diagnosis
|
||||||
|
- Can mean true cyst, pseudocyst, or cystic mass
|
||||||
|
|
||||||
|
# IMAGING
|
||||||
|
|
||||||
|
- ## General Features
|
||||||
|
|
||||||
|
|
||||||
|
- ### Best diagnostic clue
|
||||||
|
|
||||||
|
|
||||||
|
- Well-defined, nonenhancing, water-density adrenal mass ± calcifications
|
||||||
|
- ### Location
|
||||||
|
|
||||||
|
|
||||||
|
- Suprarenal
|
||||||
|
- Unilateral > bilateral (8-10% of cases)
|
||||||
|
- ### Size
|
||||||
|
|
||||||
|
|
||||||
|
- < 5 cm (50%), up to 20 cm
|
||||||
|
- ## CT Findings
|
||||||
|
|
||||||
|
|
||||||
|
- ### NECT
|
||||||
|
|
||||||
|
|
||||||
|
- Unilocular or multilocular mass
|
||||||
|
- Well-defined, round to oval, homogeneous mass usually with water (0 HU) or near-water density
|
||||||
|
- Higher- or mixed-attenuation mass (hemorrhage, intracystic debris, crystals)
|
||||||
|
- Wall usually very thin
|
||||||
|
- ↑ wall thickness, up to 3 mm for complex cysts
|
||||||
|
- Calcifications
|
||||||
|
- Rim-like or nodular (51-69%)
|
||||||
|
- Centrally in intracystic septation (19%)
|
||||||
|
- Punctate within intracystic hemorrhage (5%)
|
||||||
|
- ### CECT
|
||||||
|
|
||||||
|
|
||||||
|
- No central enhancement ± wall enhancement
|
||||||
|
- Coronal reformats helpful to determine organ of origin if large cyst
|
||||||
|
- ## MR Findings
|
||||||
|
|
||||||
|
|
||||||
|
- ### T1WI
|
||||||
|
|
||||||
|
|
||||||
|
- Homogeneous, hypointense mass
|
||||||
|
- Hyperintense mass (hemorrhage)
|
||||||
|
- ### T2WI
|
||||||
|
|
||||||
|
|
||||||
|
- Hyperintense mass
|
||||||
|
- ## Ultrasonographic Findings
|
||||||
|
|
||||||
|
|
||||||
|
- Simple or septated suprarenal cyst
|
||||||
|
- Shadowing from calcification
|
||||||
|
- Real-time examination helpful to differentiate adrenal cyst from adjacent (renal, pancreatic) cyst
|
||||||
|
- ## Imaging Recommendations
|
||||||
|
|
||||||
|
|
||||||
|
- ### Best imaging tool
|
||||||
|
|
||||||
|
|
||||||
|
- CECT or MR; US for confirmation
|
||||||
|
|
||||||
|
# DIFFERENTIAL DIAGNOSIS
|
||||||
|
|
||||||
|
- [Adrenal Adenoma](/document/adrenal-adenoma/e2916d86-5f9f-4dd3-9576-1a7b89d8dda0)
|
||||||
|
- NECT: Lipid-rich adenoma (< 10 HU) mimics adrenal cyst
|
||||||
|
- Peripheral or septal calcification favors adrenal cyst
|
||||||
|
- CECT: **Enhancing mass** without visible wall or peripheral calcifications
|
||||||
|
- Assess washout kinetics to diagnose lipid-poor adenoma
|
||||||
|
- MR: Signal suppression at out-of-phase, chemical-shift imaging
|
||||||
|
- US: Solid adrenal lesion
|
||||||
|
- [Gastric Diverticulum](/document/gastric-diverticulum/eeb101f0-8bdf-4771-b44a-fe6e73b3a463)
|
||||||
|
- May simulate left adrenal cyst
|
||||||
|
- Air-, fluid-, or contrast-filled suprarenal mass
|
||||||
|
- No enhancement
|
||||||
|
- Normal adjacent adrenal gland
|
||||||
|
- [Adrenal Myelolipoma](/document/adrenal-myelolipoma/5813a554-06a4-4696-af71-7ce50693039d)
|
||||||
|
- Fat (not fluid) attenuation mass
|
||||||
|
- ## Necrotic Adrenal Tumor
|
||||||
|
|
||||||
|
|
||||||
|
- Primary (pheochromocytoma or carcinoma) or metastatic
|
||||||
|
- Clinical history, biochemical evaluation, lesion complexity suggest correct diagnosis
|
||||||
|
- Enhancing soft tissue components
|
||||||
|
- ## Retroperitoneal Bronchogenic Cyst
|
||||||
|
|
||||||
|
|
||||||
|
- Rare, benign, suprarenal fluid or soft tissue attenuation lesion
|
||||||
|
- Adjacent to but separate from adrenal gland
|
||||||
|
- ## Renal Cyst
|
||||||
|
|
||||||
|
|
||||||
|
- Coronal MR/CT or US useful to determine organ of origin of large, retroperitoneal cystic lesions
|
||||||
|
|
||||||
|
# PATHOLOGY
|
||||||
|
|
||||||
|
- ## General Features
|
||||||
|
|
||||||
|
|
||||||
|
- ### Etiology
|
||||||
|
|
||||||
|
|
||||||
|
- Congenital (endothelial, epithelial) cysts
|
||||||
|
- Acquired (post hemorrhagic, inflammatory) pseudocysts
|
||||||
|
- Cystic, hemorrhagic degeneration of underlying adrenal neoplasm
|
||||||
|
- ## Staging, Grading, & Classification
|
||||||
|
|
||||||
|
|
||||||
|
- Accepted classification scheme
|
||||||
|
- Pseudocyst
|
||||||
|
- Most common type of cystic adrenal lesion in surgical series
|
||||||
|
- No epithelial or endothelial lining: Fibrous cyst wall
|
||||||
|
- Potentially as complication of prior trauma or hemorrhage though history of such often not elicited
|
||||||
|
- May be associated with underlying adrenal neoplasm (pheochromocytoma, adrenal carcinoma, myelolipoma)
|
||||||
|
- Attenuation and complexity at imaging varies depending upon hemorrhagic component
|
||||||
|
- Wall and septal calcification common
|
||||||
|
- Endothelial cyst
|
||||||
|
- Subtypes: Lymphangiomatous and hemangiomatous
|
||||||
|
- True cyst: Endothelial lining
|
||||||
|
- Originate from preexisting vascular malformation or obstructed, ectatic lymphatic channels
|
||||||
|
- Thin rim calcification typical
|
||||||
|
- Epithelial cyst
|
||||||
|
- Extremely rare: No acinar structures within normal adrenal gland
|
||||||
|
- Mesothelial origin suggested (mesothelial cells potentially incorporated within adrenal gland during embryogenesis)
|
||||||
|
- Parasitic (hydatid) cyst
|
||||||
|
|
||||||
|
# CLINICAL ISSUES
|
||||||
|
|
||||||
|
- ## Presentation
|
||||||
|
|
||||||
|
|
||||||
|
- ### Most common signs/symptoms
|
||||||
|
|
||||||
|
|
||||||
|
- Typically asymptomatic
|
||||||
|
- Larger cysts may be symptomatic
|
||||||
|
- Abdominal pain
|
||||||
|
- Hemorrhage
|
||||||
|
- Clinical history (malignancy, hypertension) elicited
|
||||||
|
- May indicate cystic degeneration of underlying adrenal neoplasm (e.g., metastasis, pheochromocytoma)
|
||||||
|
- Diagnosis
|
||||||
|
- Usually incidental finding at imaging
|
||||||
|
- Endocrine-biochemical evaluation performed to exclude underlying functional adrenal tumor
|
||||||
|
- ## Demographics
|
||||||
|
|
||||||
|
|
||||||
|
- ### Age
|
||||||
|
|
||||||
|
|
||||||
|
- Any, though patients 20-50 years of age most common
|
||||||
|
- ### Sex
|
||||||
|
|
||||||
|
|
||||||
|
- M:F = 1:3
|
||||||
|
- ### Epidemiology
|
||||||
|
|
||||||
|
|
||||||
|
- Uncommon entity: Autopsy incidence 0.064-0.18%
|
||||||
|
- Accounts for 1% of incidental adrenal lesions in large imaging series
|
||||||
|
- ## Natural History & Prognosis
|
||||||
|
|
||||||
|
|
||||||
|
- Complications
|
||||||
|
- Hypertension, infection, rupture, hemorrhage
|
||||||
|
- Excellent prognosis for vast majority of incidental, benign adrenal cysts
|
||||||
|
- Prognosis for pseudocysts secondary to adrenal neoplasm depends upon tumor histology
|
||||||
|
- ## Treatment
|
||||||
|
|
||||||
|
|
||||||
|
- No treatment required usually
|
||||||
|
- Imaging follow-up typically performed
|
||||||
|
- Intensity and length of surveillance not defined
|
||||||
|
- Cysts may enlarge over time
|
||||||
|
- Endocrine evaluation (cortisol, metanephrine, etc.) performed
|
||||||
|
- Surgical resection if symptomatic, underlying adrenal neoplasm
|
||||||
|
- Laparoscopic resection preferred
|
||||||
|
|
||||||
|
# DIAGNOSTIC CHECKLIST
|
||||||
|
|
||||||
|
- ## Consider
|
||||||
|
|
||||||
|
|
||||||
|
- Complicated cyst may suggest underlying adrenal neoplasm
|
||||||
|
- Clinical history, biochemical evaluation, and prior imaging helpful
|
||||||
|
- ## Image Interpretation Pearls
|
||||||
|
|
||||||
|
|
||||||
|
- Simple adrenal cyst: Scant septation, no enhancement, thin rim calcification
|
||||||
|
- Likely benign endothelial cyst or pseudocyst
|
||||||
|
- Coronal imaging helpful to determine organ of origin (and exclude exophytic renal or pancreatic cyst)
|
||||||
|
- Complicated cyst: High attenuation, thick enhancing wall, &/or septations
|
||||||
|
- Complexity may suggest underlying adrenal neoplasm and secondary pseudocyst
|
||||||
|
|
||||||
|
35fa0290-3451-422f-8726-c69b68aadbb5
|
||||||
@@ -0,0 +1,234 @@
|
|||||||
|
---
|
||||||
|
title: "Adrenal Myelolipoma"
|
||||||
|
docid: "5813a554-06a4-4696-af71-7ce50693039d"
|
||||||
|
breadcrumbs:
|
||||||
|
- "Genitourinary"
|
||||||
|
- "Diagnosis"
|
||||||
|
- "Adrenal"
|
||||||
|
- "Benign Neoplasms"
|
||||||
|
- "Adrenal Myelolipoma"
|
||||||
|
---
|
||||||
|
# KEY FACTS
|
||||||
|
|
||||||
|
- ## Terminology
|
||||||
|
|
||||||
|
|
||||||
|
- Uncommon benign tumor composed of mature fat tissue and hematopoietic elements (myeloid and erythroid cells)
|
||||||
|
- ## Imaging
|
||||||
|
|
||||||
|
|
||||||
|
- Benign, nonfunctioning adrenal tumor
|
||||||
|
- Accounts for 7-15% of incidental adrenal masses, usually in older population
|
||||||
|
- Typically unilateral and very rarely bilateral
|
||||||
|
- Large tumors can mimic retroperitoneal lipomas, liposarcomas
|
||||||
|
- Asymptomatic, though larger tumors may hemorrhage
|
||||||
|
- CT
|
||||||
|
- Lesion containing fat attenuation (-30 to -90 HU)
|
||||||
|
- Usually well-defined mass with recognizable pseudocapsule (remaining adrenal)
|
||||||
|
- Punctate calcifications seen in 24% of cases
|
||||||
|
- Coronal reconstruction helpful to differentiate from exophytic renal angiomyolipoma
|
||||||
|
- MR
|
||||||
|
- Tumor with major fat component
|
||||||
|
- T1WI in phase: Typically hyperintense
|
||||||
|
- FS sequences: Loss of signal
|
||||||
|
- ## Top Differential Diagnoses
|
||||||
|
|
||||||
|
|
||||||
|
- Adrenal adenoma
|
||||||
|
- Intracellular lipid vs. macroscopic fat
|
||||||
|
- Adrenal metastases and lymphoma
|
||||||
|
- Retroperitoneal liposarcoma
|
||||||
|
- Involving perirenal space, may simulate adrenal (or renal) fatty tumor
|
||||||
|
- Pheochromocytoma
|
||||||
|
- Highly vascular, prone to hemorrhage and necrosis
|
||||||
|
- Adrenal carcinoma
|
||||||
|
- Renal angiomyelolipoma
|
||||||
|
- Coronal CT reconstruction or MR useful to determine organ of origin
|
||||||
|
|
||||||
|
# TERMINOLOGY
|
||||||
|
|
||||||
|
- ## Definitions
|
||||||
|
|
||||||
|
|
||||||
|
- Uncommon benign tumor composed of mature adipose tissue and hematopoietic elements
|
||||||
|
|
||||||
|
# IMAGING
|
||||||
|
|
||||||
|
- ## General Features
|
||||||
|
|
||||||
|
|
||||||
|
- ### Best diagnostic clue
|
||||||
|
|
||||||
|
|
||||||
|
- Suprarenal mass containing fat
|
||||||
|
- ### Location
|
||||||
|
|
||||||
|
|
||||||
|
- Suprarenal
|
||||||
|
- Rare extraadrenal myelolipomas (presacral, retroperitoneal)
|
||||||
|
- ### Size
|
||||||
|
|
||||||
|
|
||||||
|
- Usually 2-10 cm, rarely 10-20 cm
|
||||||
|
- Key concepts
|
||||||
|
- Benign neoplasm of adrenal gland
|
||||||
|
- Autopsy prevalence rate of 0.2-0.4%
|
||||||
|
- Accounts for 7-15% of adrenal "incidentalomas"
|
||||||
|
- Usually unilateral incidental finding in older patient
|
||||||
|
- Larger tumors can bleed spontaneously
|
||||||
|
- Most are nonfunctioning (do not secrete hormones)
|
||||||
|
- Large myelolipomas can mimic retroperitoneal lipoma or liposarcoma
|
||||||
|
- ## CT Findings
|
||||||
|
|
||||||
|
|
||||||
|
- CT appearance depends on histologic composition
|
||||||
|
- Most tumors are heterogeneous adrenal masses composed of varying percentages of fat
|
||||||
|
- Low-attenuation suprarenal lesion containing fat density (-30 to -90 HU)
|
||||||
|
- Average NECT attenuation value of tumor: -74 HU in one series
|
||||||
|
- Interspersed soft tissue attenuation components: Myeloid elements, hemorrhage
|
||||||
|
- Presence of macroscopic fat within tumor is diagnostic
|
||||||
|
- Punctate calcifications seen in 24% of cases
|
||||||
|
- Usually well-defined mass with recognizable pseudocapsule (remnant adrenal)
|
||||||
|
- Coronal reconstructions may help determine organ of origin: Adrenal myelolipoma vs. exophytic renal angiomyelolipoma
|
||||||
|
- ## MR Findings
|
||||||
|
|
||||||
|
|
||||||
|
- MR appearance depends on histologic composition
|
||||||
|
- Tumor with major fat component
|
||||||
|
- T1WI in phase: Typically hyperintense
|
||||||
|
- T1WI out phase: Persistent hyperintensity of macroscopic fat
|
||||||
|
- T1WI FS: Confirmatory suppression of signal
|
||||||
|
- Bone marrow elements (myeloid and erythroid cells)
|
||||||
|
- Low signal on T1WI, moderate signal on T2WI
|
||||||
|
- Hemorrhage: Varying T1, T2 signal depending on age of blood
|
||||||
|
- ## Ultrasonographic Findings
|
||||||
|
|
||||||
|
|
||||||
|
- ### Grayscale ultrasound
|
||||||
|
|
||||||
|
|
||||||
|
- Well-defined, echogenic mass (↑ fat tissue)
|
||||||
|
- Often overlooked: Lack of mass effect and isoechogenicity relative to retroperitoneal fat
|
||||||
|
- Heterogeneous mass (↑ myeloid cells)
|
||||||
|
- ## Angiographic Findings
|
||||||
|
|
||||||
|
|
||||||
|
- Conventional
|
||||||
|
- Differentiate myelolipoma from retroperitoneal liposarcoma by determining origin of blood supply and vascularity of tumors
|
||||||
|
- ## Nuclear Medicine Findings
|
||||||
|
|
||||||
|
|
||||||
|
- Typically not metabolically active, though uptake reported at FDG PET
|
||||||
|
- ## Imaging Recommendations
|
||||||
|
|
||||||
|
|
||||||
|
- Helical NECT or MR with FS sequence
|
||||||
|
|
||||||
|
# DIFFERENTIAL DIAGNOSIS
|
||||||
|
|
||||||
|
- [Adrenal Adenoma](/document/adrenal-adenoma/e2916d86-5f9f-4dd3-9576-1a7b89d8dda0)
|
||||||
|
- Lipid-rich adenoma: ↓ attenuation (< 10 HU) at NECT
|
||||||
|
- Can contain small amounts of macroscopic fat due to lipomatous metaplasia
|
||||||
|
- CECT: Washout 15 minutes post injection: > 50%
|
||||||
|
- Relative washout: > 40%
|
||||||
|
- Absolute washout: > 60%
|
||||||
|
- [Metastases and Lymphoma, Adrenal](/document/adrenal-lymphoma/44639c90-bd04-4e2a-a470-2c28a0e2ff78)
|
||||||
|
- Bilateral lesions: Clinical history paramount
|
||||||
|
- Metastases: Soft tissue attenuation (signal)
|
||||||
|
- Lymphoma: May maintain adreniform shape, adjacent retroperitoneal adenopathy
|
||||||
|
- [Liposarcoma, Retroperitoneal](/document/retroperitoneal-sarcoma/c1466b30-b730-41c4-a065-2c2de018a5f7)
|
||||||
|
- Retroperitoneal primary sarcoma involving perirenal space may simulate adrenal (or renal) fatty tumor
|
||||||
|
- [Pheochromocytoma](/document/pheochromocytoma/7d3c4062-643c-4030-8783-f85184ad8132)
|
||||||
|
- Highly vascular, prone to hemorrhage and necrosis
|
||||||
|
- Hyperintense on T2WI, bilateral in multiple endocrine neoplasia syndromes (MEN) syndromes
|
||||||
|
- Clinical history (labile hypertension) and urinary catecholamines
|
||||||
|
- [Adrenal Carcinoma](/document/adrenal-cortical-carcinoma/bdc7a08b-a64f-4bd2-9dfc-24331728e85e)
|
||||||
|
- Rare, unilateral, invasive, enhancing mass
|
||||||
|
- Venous invasion, distant metastases
|
||||||
|
- May contain fat: Engulfed retroperitoneal fat vs. lipomatous metaplasia
|
||||||
|
- ## Renal Angiomyelolipoma
|
||||||
|
|
||||||
|
|
||||||
|
- Exophytic upper pole angiomyolipoma may mimic
|
||||||
|
- Coronal reconstruction/MR helpful to determine organ of origin
|
||||||
|
|
||||||
|
# PATHOLOGY
|
||||||
|
|
||||||
|
- ## General Features
|
||||||
|
|
||||||
|
|
||||||
|
- ### Etiology
|
||||||
|
|
||||||
|
|
||||||
|
- Unknown
|
||||||
|
- Best hypothesis: Reticuloendothelial cell metaplasia of capillaries in adrenal (stress/infection/necrosis)
|
||||||
|
- Secondary hypothesis: Myelolipoma represents site of extramedullary hematopoiesis
|
||||||
|
- ### Associated abnormalities
|
||||||
|
|
||||||
|
|
||||||
|
- Adrenal collision tumors (coexistent myelolipoma and adenoma typical)
|
||||||
|
- Large, bilateral myelolipomas reported with longstanding, poorly treated congenital adrenal hyperplasia
|
||||||
|
- ## Gross Pathologic & Surgical Features
|
||||||
|
|
||||||
|
|
||||||
|
- Cut section: Fat, soft tissue components
|
||||||
|
- ## Microscopic Features
|
||||||
|
|
||||||
|
|
||||||
|
- Mature fat cells and megakaryocytes; no malignant cells
|
||||||
|
- Calcification
|
||||||
|
- Hemorrhage within larger lesions
|
||||||
|
|
||||||
|
# CLINICAL ISSUES
|
||||||
|
|
||||||
|
- ## Presentation
|
||||||
|
|
||||||
|
|
||||||
|
- ### Most common signs/symptoms
|
||||||
|
|
||||||
|
|
||||||
|
- Asymptomatic
|
||||||
|
- Usually incidental finding on CT, MR
|
||||||
|
- Typically biochemically nonfunctioning
|
||||||
|
- Symptomatic
|
||||||
|
- Acute abdomen: Flank pain due to rupture and hemorrhage
|
||||||
|
- Case reports of hormonally active tumors: Cushing, Conn syndromes, virilization
|
||||||
|
- Diagnosis: Pathognomonic MR/CT features
|
||||||
|
- Biopsy reserved for larger, atypical lesions, though prone to sampling error
|
||||||
|
- ## Demographics
|
||||||
|
|
||||||
|
|
||||||
|
- ### Age
|
||||||
|
|
||||||
|
|
||||||
|
- Usually older patients (50-70 years old)
|
||||||
|
- ### Epidemiology
|
||||||
|
|
||||||
|
|
||||||
|
- Autopsy incidence: 0.2-0.4%
|
||||||
|
- ## Natural History & Prognosis
|
||||||
|
|
||||||
|
|
||||||
|
- Complication: Rupture with hemorrhage (rare)
|
||||||
|
- Prognosis: Excellent
|
||||||
|
- ## Treatment
|
||||||
|
|
||||||
|
|
||||||
|
- When diagnosis is certain, surgery not needed for lesions < 5-7 cm
|
||||||
|
- Surgery reserved for larger, symptomatic, or atypical lesions
|
||||||
|
- Surgical series have confirmed utility of laparoscopic resection
|
||||||
|
|
||||||
|
# DIAGNOSTIC CHECKLIST
|
||||||
|
|
||||||
|
- ## Consider
|
||||||
|
|
||||||
|
|
||||||
|
- Differentiate from other tumors (lipid-rich adenoma)
|
||||||
|
- Key is presence of imaging-apparent adipose tissue; avoid further work-up for incidental mass
|
||||||
|
- ## Image Interpretation Pearls
|
||||||
|
|
||||||
|
|
||||||
|
- Well-defined, heterogeneous, fat-attenuation tumor on CT
|
||||||
|
- T1 hyperintense, signal loss with fat suppression
|
||||||
|
|
||||||
|
81ce3ad3-c446-4b08-8b87-df9511f95360
|
||||||
@@ -0,0 +1,113 @@
|
|||||||
|
---
|
||||||
|
title: "Adrenal"
|
||||||
|
docid: "082ca43c-db5c-4770-aeed-0c6ea317e8fc"
|
||||||
|
breadcrumbs:
|
||||||
|
- "Genitourinary"
|
||||||
|
- "Anatomy"
|
||||||
|
- "Adrenal"
|
||||||
|
---
|
||||||
|
# TERMINOLOGY
|
||||||
|
|
||||||
|
- ## Abbreviations
|
||||||
|
|
||||||
|
|
||||||
|
- Adrenal corticotrophic hormone (ACTH)
|
||||||
|
|
||||||
|
# GROSS ANATOMY
|
||||||
|
|
||||||
|
- ## Overview
|
||||||
|
|
||||||
|
|
||||||
|
- Adrenal (**suprarenal**) glands are part of endocrine and neurological systems
|
||||||
|
- Essentially different organs within same structure, composed of thick outer cortex and thin inner medulla
|
||||||
|
- Lie within**perirenal space**bilaterally, bounded by**renal** (**perirenal**)**fascia**, above/medial to kidneys
|
||||||
|
- Composed of "body" and 2 limbs (medial and lateral)
|
||||||
|
- ## Anatomic Relationships
|
||||||
|
|
||||||
|
|
||||||
|
- Right adrenal is usually more apical in location
|
||||||
|
- Lies anterolateral to right crus of diaphragm, medial to liver, and posterior to inferior vena cava (IVC)
|
||||||
|
- Often pyramidal in shape with inverted V shape on transverse section
|
||||||
|
- Left adrenal is usually more caudal and lies medial to upper pole of left kidney, lateral to left crus of diaphragm, and posterior to splenic vein and pancreas
|
||||||
|
- Often crescentic in shape with λ or triangular shape on transverse section
|
||||||
|
- ## Divisions
|
||||||
|
|
||||||
|
|
||||||
|
- **Adrenal cortex**
|
||||||
|
- Embryologically derived from mesoderm
|
||||||
|
- Divided into 3 distinct zones (zona glomerulosa, zona fasciculata, and zona reticularis)
|
||||||
|
- Secretes **mineralocorticoids**(aldosterone) from zona glomerulosa, **glucocorticoids**(cortisol) from zona fasciculata, and **androgens**from zona reticularis
|
||||||
|
- **Adrenal medulla**
|
||||||
|
- Embryologically derived from neural crest
|
||||||
|
- Part of sympathetic nervous system
|
||||||
|
- **Chromaffin cells** secrete **catecholamines** (mostly epinephrine) into bloodstream
|
||||||
|
- **Vessels**,**nerves**, and **lymphatics**
|
||||||
|
- Arteries
|
||||||
|
- **Superior adrenal arteries**: Typically 6-8; from inferior phrenic arteries
|
||||||
|
- **Middle adrenal artery**: 1; from abdominal aorta
|
||||||
|
- **Inferior adrenal artery**: 1; from renal arteries
|
||||||
|
- Veins
|
||||||
|
- **Right adrenal vein** drains into IVC
|
||||||
|
- **Left adrenal vein** drains into left renal vein (usually after joining left inferior phrenic vein)
|
||||||
|
- Nerves
|
||||||
|
- Extensive sympathetic connection to adrenal medulla
|
||||||
|
- Presynaptic sympathetic fibers from paravertebral ganglia end directly on secretory cells of medulla
|
||||||
|
- Lymphatics
|
||||||
|
- Drain to **lumbar** (**aortic** and **caval**) **nodes**
|
||||||
|
|
||||||
|
# ANATOMY IMAGING ISSUES
|
||||||
|
|
||||||
|
- ## Multimodality Imaging Appearance
|
||||||
|
|
||||||
|
|
||||||
|
- No consensus on "normal" size or thickness of adrenals but average thickness of ~ 3 mm for medial/lateral limbs
|
||||||
|
- While not based on any strong evidence, > 10-mm thickness can be used as threshold for hyperplasia
|
||||||
|
- MR: Generally isointense to liver on T1 MR and isointense to slightly hyperintense to liver on T2 MR
|
||||||
|
- Ultrasound: Easiest to visualize in newborns (as result of physiologic enlargement) and become progressively more difficult to visualize with age
|
||||||
|
- Right adrenal gland easier to visualize than left (due to lack of liver as acoustic window and overlying bowel gas)
|
||||||
|
- Adrenal glands in adults usually hypoechoic (juxtaposed against hyperechoic periadrenal fat), although medulla can rarely be discretely seen and appears hyperechoic
|
||||||
|
- ## Key Concepts
|
||||||
|
|
||||||
|
|
||||||
|
- **Adrenal** (**cortical**) **adenomas**
|
||||||
|
- Very common (at least 2% of general population) but usually cause no symptoms
|
||||||
|
- Mostly "nonfunctioning" but identical to "functional" adenomas that cause Cushing/Conn syndrome
|
||||||
|
- Most adenomas contain abundant lipid (precursor to steroid hormones), allowing definitive diagnosis using CT/MR sequences that highlight lipid
|
||||||
|
- Lipid is intracellular/intercellular (not macroscopic deposits of fat)
|
||||||
|
- Best CT technique: Nonenhanced CT with nodule measuring < 10 HU; or multiphase-enhanced CT with nodule demonstrating "washout" kinetics
|
||||||
|
- Best MR technique: Chemical-shift MR with signal dropout within nodule on opposed-phase images
|
||||||
|
- Standard imaging features for diagnosis of adenoma should be used for nodules measuring < 4 cm, while lesions > 4 cm should raise concern for malignancy
|
||||||
|
- **Pheochromocytoma** (tumor of adrenal medulla)
|
||||||
|
- Signs: Headache, palpitations, excessive perspiration
|
||||||
|
- 90% arise in adrenal, 90% unilateral, 90% benign
|
||||||
|
- Similar tumor arising in other chromaffin cells of sympathetic ganglia is called **paraganglioma**
|
||||||
|
- More common with multiple endocrine neoplasia, neurofibromatosis, and von Hippel-Lindau
|
||||||
|
- Often markedly hypervascular in arterial phase
|
||||||
|
- **Adrenal myelolipoma**
|
||||||
|
- Uncommon benign tumor (usually incidental finding) composed of mature adipose and hematopoietic tissue
|
||||||
|
- Characterized by presence of **macroscopic fat**
|
||||||
|
- May have internal soft tissue component or calcification
|
||||||
|
- **Adrenocortical carcinoma**
|
||||||
|
- Highly aggressive malignancy with poor prognosis
|
||||||
|
- Large, heterogeneous mass (often with necrosis, hemorrhage, or calcification) with frequent local invasion, vascular invasion, and distant metastases
|
||||||
|
- **Cushing syndrome** (excess cortisol)
|
||||||
|
- Signs: Truncal obesity, hirsutism, hypertension
|
||||||
|
- Causes: Pituitary tumors (→ adrenal corticotrophic hormone), exogenous (medications) > adrenal adenoma > carcinoma
|
||||||
|
- **Conn syndrome** (excess aldosterone)
|
||||||
|
- Signs: Hypertension, hypokalemic alkalosis
|
||||||
|
- Causes: Adrenal adenomas > hyperplasia > carcinoma
|
||||||
|
- **Addison syndrome**(adrenal insufficiency)
|
||||||
|
- Signs: Hypotension, weight loss, altered pigmentation
|
||||||
|
- Causes: Autoimmune disease > adrenal metastases > adrenal hemorrhage > adrenal infection
|
||||||
|
|
||||||
|
# CLINICAL IMPLICATIONS
|
||||||
|
|
||||||
|
- ## Clinical Importance
|
||||||
|
|
||||||
|
|
||||||
|
- Rich adrenal blood supply due to endocrine function
|
||||||
|
- Results in adrenal glands being common site for hematologic **metastases** (lung, breast, melanoma, etc.)
|
||||||
|
- Adrenal glands respond to stress (trauma, sepsis, surgery, etc.) by secreting ↑ cortisol and epinephrine
|
||||||
|
- Overwhelming stress may result in **adrenal hemorrhage**or acute adrenal insufficiency (addisonian crisis)
|
||||||
|
|
||||||
|
d7703d36-250d-428e-bf99-6439a7cdc980
|
||||||
-19
@@ -1,19 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/24559f7a-ed5a-4ab6-90ba-769f0b5c1197/media"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
{
|
|
||||||
"groupId": "e2f10f6a-0bef-498b-9eb3-1b9558473bfa",
|
|
||||||
"name": "Selected Images",
|
|
||||||
"images": [
|
|
||||||
{
|
|
||||||
"imageId": "444b7609-9961-4277-a969-7a56d10a6b02",
|
|
||||||
"caption": "Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia , a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.",
|
|
||||||
"title": "Enlarged Perivascular Spaces",
|
|
||||||
"enhancedTitle": "Enlarged Perivascular Spaces",
|
|
||||||
"annotated": true,
|
|
||||||
"flanked": false,
|
|
||||||
"documentId": "24559f7a-ed5a-4ab6-90ba-769f0b5c1197",
|
|
||||||
"documentUrl": "/document/v2/24559f7a-ed5a-4ab6-90ba-769f0b5c1197",
|
|
||||||
"imageTitle": "Enlarged Perivascular Spaces",
|
|
||||||
"thumbnailUrl": "
|
|
||||||
-19
@@ -1,19 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/24559f7a-ed5a-4ab6-90ba-769f0b5c1197/media"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
{
|
|
||||||
"groupId": "e2f10f6a-0bef-498b-9eb3-1b9558473bfa",
|
|
||||||
"name": "Selected Images",
|
|
||||||
"images": [
|
|
||||||
{
|
|
||||||
"imageId": "444b7609-9961-4277-a969-7a56d10a6b02",
|
|
||||||
"caption": "Axial T2 MR shows a cluster of CSF-like cysts in the inferior left basal ganglia , a common location for enlarged perivascular spaces. They are often seen at the level of the anterior commissure.",
|
|
||||||
"title": "Enlarged Perivascular Spaces",
|
|
||||||
"enhancedTitle": "Enlarged Perivascular Spaces",
|
|
||||||
"annotated": true,
|
|
||||||
"flanked": false,
|
|
||||||
"documentId": "24559f7a-ed5a-4ab6-90ba-769f0b5c1197",
|
|
||||||
"documentUrl": "/document/v2/24559f7a-ed5a-4ab6-90ba-769f0b5c1197",
|
|
||||||
"imageTitle": "Enlarged Perivascular Spaces",
|
|
||||||
"thumbnailUrl": "
|
|
||||||
-19
@@ -1,19 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/49510d0e-acf7-45cb-9eb1-53f8193b0b6d/media"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
{
|
|
||||||
"groupId": "415b02cf-df4f-4cef-9c2b-866ef0618ec0",
|
|
||||||
"name": "Selected Images",
|
|
||||||
"images": [
|
|
||||||
{
|
|
||||||
"imageId": "ccf3ab42-d18d-44f4-9b3f-cc9fd9510d11",
|
|
||||||
"caption": "Graphic depicts the classic disproportionate frontal lobe atrophy of late-stage frontotemporal dementia (FTD). The sulci are widened & gyri are knife-like . Parietooccipital lobes are spared. Gyri around the central sulcus are normal.",
|
|
||||||
"title": "",
|
|
||||||
"enhancedTitle": "",
|
|
||||||
"annotated": true,
|
|
||||||
"flanked": false,
|
|
||||||
"documentId": "49510d0e-acf7-45cb-9eb1-53f8193b0b6d",
|
|
||||||
"documentUrl": "/document/v2/49510d0e-acf7-45cb-9eb1-53f8193b0b6d",
|
|
||||||
"imageTitle": "",
|
|
||||||
"thumbnailUrl": "/image/thumbnail/ccf3ab42-d18d-44f4-9b3f-
|
|
||||||
-10
@@ -1,10 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/49510d0e-acf7-45cb-9eb1-53f8193b0b6d/tables"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
"
|
|
||||||
# Imaging Features for Various Clinical Subtypes of Frontotemporal Dementia
|
|
||||||
|
|
||||||
| Clinical Subtypes | Imaging Features |
|
|
||||||
| --- | --- |
|
|
||||||
| bvFTD | MR: Atrophy of frontal & temporal lobes; asymmetric right frontal &/or temporal lobe atrophy may occur NM: Decreased perfusion & metabolism in frontal &/or te |
|
|
||||||
-20
@@ -1,20 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/9f9eda8c-7e3c-4292-9861-4b8abc2c6474/media"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
{
|
|
||||||
"groupId": "fb01ca50-5af0-419d-ad89-6f4f2d980fd2",
|
|
||||||
"name": "Selected Images",
|
|
||||||
"images": [
|
|
||||||
{
|
|
||||||
"imageId": "01274ce7-fce5-4f42-bd69-b5a99e6a4930",
|
|
||||||
"caption": "Axial F-18 FDG PET shows findings associated with frontotemporal dementia (FTD), predominantly frontal  and temporal lobe hypometabolism. Functional changes may occur prior to CT or MR changes.",
|
|
||||||
"title": "",
|
|
||||||
"enhancedTitle": "",
|
|
||||||
"annotated": true,
|
|
||||||
"flanked": false,
|
|
||||||
"documentId": "9f9eda8c-7e3c-4292-9861-4b8abc2c6474",
|
|
||||||
"documentUrl": "/document/v2/9f9eda8c-7e3c-4292-9861-4b8abc2c6474",
|
|
||||||
"imageTitle": "",
|
|
||||||
"thumbnailUrl": "/image/thumbnail/01274ce7-fce5-4f42-bd69-b5a99e6a4930?size=168&quality=85"
|
|
||||||
},
|
|
||||||
-14
@@ -1,14 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/24559f7a-ed5a-4ab6-90ba-769f0b5c1197"
|
|
||||||
---
|
|
||||||
# ESSENTIAL INFORMATION
|
|
||||||
|
|
||||||
- ## Key Differential Diagnosis Issues
|
|
||||||
|
|
||||||
|
|
||||||
- Key imaging questions
|
|
||||||
- Does lesion follow CSF on all modalities/sequences?
|
|
||||||
- Is there any associated mass effect?
|
|
||||||
- Does lesion enhance?
|
|
||||||
|
|
||||||
</l
|
|
||||||
-14
@@ -1,14 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/24559f7a-ed5a-4ab6-90ba-769f0b5c1197"
|
|
||||||
---
|
|
||||||
# ESSENTIAL INFORMATION
|
|
||||||
|
|
||||||
- ## Key Differential Diagnosis Issues
|
|
||||||
|
|
||||||
|
|
||||||
- Key imaging questions
|
|
||||||
- Does lesion follow CSF on all modalities/sequences?
|
|
||||||
- Is there any associated mass effect?
|
|
||||||
- Does lesion enhance?
|
|
||||||
|
|
||||||
</l
|
|
||||||
-10
@@ -1,10 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/834ccc3e-2116-4295-8408-0ac9a06bd2ff"
|
|
||||||
---
|
|
||||||
# KEY FACTS
|
|
||||||
|
|
||||||
- ## Terminology
|
|
||||||
|
|
||||||
|
|
||||||
- Normal-pressure hydrocephalus (NPH): Ventriculomegaly out of proportion to sulcal enlargement in setting of normal cerebrospinal fluid (CSF) pressure
|
|
||||||
- ## Imaging</h
|
|
||||||
-10
@@ -1,10 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/9f9eda8c-7e3c-4292-9861-4b8abc2c6474"
|
|
||||||
---
|
|
||||||
# KEY FACTS
|
|
||||||
|
|
||||||
- ## Terminology
|
|
||||||
|
|
||||||
|
|
||||||
- Frontotemporal dementia (FTD): Progressive neurodegenerative disorder of frontal/anterior temporal lobes
|
|
||||||
- ## Imaging
|
|
||||||
-10
@@ -1,10 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/a1bedda5-6478-40b2-98e7-6c5f5363b06f"
|
|
||||||
---
|
|
||||||
# IMAGING ANATOMY
|
|
||||||
|
|
||||||
- ## Overview
|
|
||||||
|
|
||||||
|
|
||||||
- Attention control network is a constellation of distributed brain networks processing attention to external stimuli and symbols
|
|
||||||
- Many aliases: Task-positive network, frontoparietal network, executive control network, and central executiv
|
|
||||||
-10
@@ -1,10 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/a1bedda5-6478-40b2-98e7-6c5f5363b06f"
|
|
||||||
---
|
|
||||||
# IMAGING ANATOMY
|
|
||||||
|
|
||||||
- ## Overview
|
|
||||||
|
|
||||||
|
|
||||||
- Attention control network is a constellation of distributed brain networks processing attention to external stimuli and symbols
|
|
||||||
- Many aliases: Task-positive network, frontoparietal network, executive control network, and central executiv
|
|
||||||
-10
@@ -1,10 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/e1b27954-6591-4bb0-a659-b13790492620"
|
|
||||||
---
|
|
||||||
# KEY FACTS
|
|
||||||
|
|
||||||
- ## Terminology
|
|
||||||
|
|
||||||
|
|
||||||
- Creutzfeldt-Jakob disease (CJD): Rapidly progressing, fatal, potentially transmissible dementia caused by prion
|
|
||||||
- ## Imaging
|
|
||||||
-11
@@ -1,11 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/content/e8e46d1d-46d2-4e5a-880f-f025a84c5871"
|
|
||||||
---
|
|
||||||
# KEY FACTS
|
|
||||||
|
|
||||||
- ## Terminology
|
|
||||||
|
|
||||||
|
|
||||||
- Progressive neurodegenerative dementia
|
|
||||||
- Parkinsonism, visual hallucinations prominent
|
|
||||||
- Caused by abnormal accumulation of α-synuclein protein
|
|
||||||
-17
@@ -1,17 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/e1b27954-6591-4bb0-a659-b13790492620/media"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
{
|
|
||||||
"groupId": "a8f1dd51-2e0e-4f07-af00-6623d1c4e2d4",
|
|
||||||
"name": "Selected Images",
|
|
||||||
"images": [
|
|
||||||
{
|
|
||||||
"imageId": "e4dd9275-5048-4513-8288-980aa8250267",
|
|
||||||
"caption": "A 53-year-old man with rapidly progressing cognitive decline due to sporadic Creutzfeldt-Jakob disease (sCJD) is shown. Axial DWI MR demonstrates symmetric bilateral basal ganglia (BG) diffusion restriction  and asymmetric cortical restricted diffusion (cortical ribbon sign) in bilateral (right > > left) hemispheres .",
|
|
||||||
"title": "",
|
|
||||||
"enhancedTitle": "",
|
|
||||||
"annotated": true,
|
|
||||||
"flanked": false,
|
|
||||||
"documentId": "e1b27954-6591-4bb0-a659-b13790492620",
|
|
||||||
"documentUrl": "/document/v2/e1b27954-6591
|
|
||||||
-14
@@ -1,14 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/e8e46d1d-46d2-4e5a-880f-f025a84c5871/media"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
{
|
|
||||||
"groupId": "210f7378-e2e6-472b-b1ad-2571bafd02be",
|
|
||||||
"name": "Selected Images",
|
|
||||||
"images": [
|
|
||||||
{
|
|
||||||
"imageId": "d2ff700c-f618-401b-94df-595198c45827",
|
|
||||||
"caption": "Right & left medial sagittal FDG PET source & 3DSSP images of a 74-year-old man with dementia with Lewy bodies (DLB) presenting with visual hallucinations show severe ↓ metabolic activity in left visual cortex  & precuneus . Note moderate ↓ metabolic activity in right occipital lobe  & precuneus  & relative sparing of bilateral posterior cingulate gyri .",
|
|
||||||
"title": "",
|
|
||||||
"enhancedTitle": "",
|
|
||||||
"annotated":
|
|
||||||
-19
@@ -1,19 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/document/f59dab57-c511-4369-8fcc-592421a4b8d1/media"
|
|
||||||
---
|
|
||||||
[
|
|
||||||
{
|
|
||||||
"groupId": "bce2eb1d-5b42-493d-b6f2-86c7fb747dcb",
|
|
||||||
"name": "Selected Images",
|
|
||||||
"images": [
|
|
||||||
{
|
|
||||||
"imageId": "add7af59-3e22-4ebd-bda3-585280f734e0",
|
|
||||||
"caption": "Axial graphic of vascular dementia (VaD) shows diffuse cerebral atrophy, focal volume loss due to multiple chronic infarcts , an acute left occipital lobe infarct , and small lacunar infarcts in the basal ganglia/thalami .",
|
|
||||||
"title": "",
|
|
||||||
"enhancedTitle": "",
|
|
||||||
"annotated": true,
|
|
||||||
"flanked": false,
|
|
||||||
"documentId": "f59dab57-c511-4369-8fcc-592421a4b8d1",
|
|
||||||
"documentUrl": "/document/v2/f59dab57-c511-4369-8fcc-592421a4b8d1",
|
|
||||||
"imageTitle": "",
|
|
||||||
"thumbnailUr
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
Vendored
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/main"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/tree/brain/6d8829f1-14d7-45af-8675-255189aa526a"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/tree/brain/6d8829f1-14d7-45af-8675-255189aa526a"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/tree/brain/6d8829f1-14d7-45af-8675-255189aa526a"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/tree/brain/6d8829f1-14d7-45af-8675-255189aa526a"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/tree/brain/6d8829f1-14d7-45af-8675-255189aa526a"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/tree/brain/6d8829f1-14d7-45af-8675-255189aa526a"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
-4
@@ -1,4 +0,0 @@
|
|||||||
---
|
|
||||||
title: "https://app.statdx.com/tree/brain/6d8829f1-14d7-45af-8675-255189aa526a"
|
|
||||||
---
|
|
||||||
html
|
|
||||||
@@ -88,6 +88,30 @@ async def run(args):
|
|||||||
async with capture_count_lock:
|
async with capture_count_lock:
|
||||||
print(f"[heartbeat] captured={capture_count}")
|
print(f"[heartbeat] captured={capture_count}")
|
||||||
|
|
||||||
|
# Build an in-memory index of content_hash -> list of index entries for quick dedupe lookups.
|
||||||
|
# If older index lines lack a content_hash but reference a body file, hash that file once at startup.
|
||||||
|
in_memory_index = {}
|
||||||
|
try:
|
||||||
|
if index_path.exists():
|
||||||
|
with open(index_path, 'r', encoding='utf-8') as idxf:
|
||||||
|
for line in idxf:
|
||||||
|
try:
|
||||||
|
j = json.loads(line)
|
||||||
|
except Exception:
|
||||||
|
continue
|
||||||
|
ch = j.get('content_hash')
|
||||||
|
body = j.get('body_file')
|
||||||
|
if not ch and body and os.path.exists(body):
|
||||||
|
try:
|
||||||
|
with open(body, 'rb') as bf:
|
||||||
|
ch = hashlib.sha256(bf.read()).hexdigest()
|
||||||
|
except Exception:
|
||||||
|
ch = None
|
||||||
|
if ch:
|
||||||
|
in_memory_index.setdefault(ch, []).append(j)
|
||||||
|
except Exception:
|
||||||
|
in_memory_index = {}
|
||||||
|
|
||||||
async with async_playwright() as p:
|
async with async_playwright() as p:
|
||||||
browser_type = p.chromium
|
browser_type = p.chromium
|
||||||
# Launch persistent context
|
# Launch persistent context
|
||||||
@@ -102,6 +126,82 @@ async def run(args):
|
|||||||
|
|
||||||
page = await context.new_page()
|
page = await context.new_page()
|
||||||
|
|
||||||
|
async def attempt_autologin(page, username: str, password: str, post_login_selector: str, wait_after: float = 1.0):
|
||||||
|
"""Async form-based autologin similar to save_page_snapshots.attempt_autologin."""
|
||||||
|
if not username or not password:
|
||||||
|
return False
|
||||||
|
# selectors
|
||||||
|
user_selectors = ['input[name="username"]', 'input.usernameSelector', 'input[type="email"]', 'input[name*="email" i]', 'input[name*="user" i]', 'input[type="text"]']
|
||||||
|
pass_selectors = ['input[type="password"]', 'input[name="password"]', 'input.passwordSelector']
|
||||||
|
|
||||||
|
user_sel = None
|
||||||
|
for sel in user_selectors:
|
||||||
|
try:
|
||||||
|
el = await page.query_selector(sel)
|
||||||
|
if el:
|
||||||
|
user_sel = sel
|
||||||
|
break
|
||||||
|
except Exception:
|
||||||
|
continue
|
||||||
|
|
||||||
|
pass_sel = None
|
||||||
|
for sel in pass_selectors:
|
||||||
|
try:
|
||||||
|
el = await page.query_selector(sel)
|
||||||
|
if el:
|
||||||
|
pass_sel = sel
|
||||||
|
break
|
||||||
|
except Exception:
|
||||||
|
continue
|
||||||
|
|
||||||
|
if not user_sel or not pass_sel:
|
||||||
|
try:
|
||||||
|
with open(output / '_debug_events.log', 'a', encoding='utf-8') as dbg:
|
||||||
|
dbg.write(f"{now_ts()}\tAUTOLOGIN\tselectors_missing\n")
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
return False
|
||||||
|
|
||||||
|
try:
|
||||||
|
await page.fill(user_sel, username)
|
||||||
|
await asyncio.sleep(0.1)
|
||||||
|
await page.fill(pass_sel, password)
|
||||||
|
await asyncio.sleep(0.1)
|
||||||
|
# try submit
|
||||||
|
submit_selectors = ['button[type=submit]', 'input[type=submit]', 'button:has-text("Sign in")', 'button:has-text("Sign In")', 'button:has-text("Log in")']
|
||||||
|
clicked = False
|
||||||
|
for s in submit_selectors:
|
||||||
|
try:
|
||||||
|
btn = await page.query_selector(s)
|
||||||
|
if btn:
|
||||||
|
await btn.click()
|
||||||
|
clicked = True
|
||||||
|
break
|
||||||
|
except Exception:
|
||||||
|
continue
|
||||||
|
if not clicked:
|
||||||
|
try:
|
||||||
|
await page.press(pass_sel, 'Enter')
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
|
||||||
|
# wait for post-login selector
|
||||||
|
try:
|
||||||
|
if post_login_selector:
|
||||||
|
await page.wait_for_selector(post_login_selector, timeout=10000)
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
await asyncio.sleep(wait_after)
|
||||||
|
return True
|
||||||
|
except Exception:
|
||||||
|
try:
|
||||||
|
with open(output / '_debug_events.log', 'a', encoding='utf-8') as dbg:
|
||||||
|
dbg.write(f"{now_ts()}\tAUTOLOGIN\tfailed_exception\n")
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
return False
|
||||||
|
|
||||||
|
|
||||||
async def on_response(resp):
|
async def on_response(resp):
|
||||||
nonlocal capture_count
|
nonlocal capture_count
|
||||||
try:
|
try:
|
||||||
@@ -237,6 +337,51 @@ async def run(args):
|
|||||||
# skip if still failing
|
# skip if still failing
|
||||||
return
|
return
|
||||||
|
|
||||||
|
# compute content hash for dedupe
|
||||||
|
content_hash = None
|
||||||
|
try:
|
||||||
|
if 'txt' in locals() and isinstance(txt, str):
|
||||||
|
content_hash = hashlib.sha256(txt.encode('utf-8')).hexdigest()
|
||||||
|
elif 'pretty' in locals() and isinstance(pretty, str):
|
||||||
|
content_hash = hashlib.sha256(pretty.encode('utf-8')).hexdigest()
|
||||||
|
elif 'data' in locals() and isinstance(data, (bytes, bytearray)):
|
||||||
|
content_hash = hashlib.sha256(data).hexdigest()
|
||||||
|
except Exception:
|
||||||
|
content_hash = None
|
||||||
|
|
||||||
|
# prepare the meta filename we'll write for this response
|
||||||
|
new_meta_name = f"{safe}_{h}_{ts}.meta.json"
|
||||||
|
new_meta_abs = os.path.abspath(str(output / new_meta_name))
|
||||||
|
|
||||||
|
# If older responses exist with the same content, delete them (fast in-memory lookup)
|
||||||
|
try:
|
||||||
|
matches = in_memory_index.get(content_hash, []) if content_hash else []
|
||||||
|
for j in matches:
|
||||||
|
body = j.get('body_file')
|
||||||
|
metaf = j.get('meta_file')
|
||||||
|
try:
|
||||||
|
if body and os.path.exists(body) and os.path.abspath(body) != os.path.abspath(body_path):
|
||||||
|
os.remove(body)
|
||||||
|
try:
|
||||||
|
with open(output / '_debug_events.log', 'a', encoding='utf-8') as dbg:
|
||||||
|
dbg.write(f"{now_ts()}\tDELETED_OLD_BODY\t{body}\n")
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
try:
|
||||||
|
if metaf and os.path.exists(metaf) and os.path.abspath(metaf) != new_meta_abs:
|
||||||
|
os.remove(metaf)
|
||||||
|
try:
|
||||||
|
with open(output / '_debug_events.log', 'a', encoding='utf-8') as dbg:
|
||||||
|
dbg.write(f"{now_ts()}\tDELETED_OLD_META\t{metaf}\n")
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
|
||||||
meta = {
|
meta = {
|
||||||
'url': url,
|
'url': url,
|
||||||
'resource_type': rtype,
|
'resource_type': rtype,
|
||||||
@@ -245,12 +390,17 @@ async def run(args):
|
|||||||
'response_headers': resp_headers,
|
'response_headers': resp_headers,
|
||||||
'response_body_file': body_path,
|
'response_body_file': body_path,
|
||||||
'response_excerpt': excerpt,
|
'response_excerpt': excerpt,
|
||||||
|
'content_hash': content_hash,
|
||||||
}
|
}
|
||||||
meta_name = f"{safe}_{h}_{ts}.meta.json"
|
meta_name = f"{safe}_{h}_{ts}.meta.json"
|
||||||
save_text(output / meta_name, json.dumps(meta, ensure_ascii=False, indent=2))
|
save_text(output / meta_name, json.dumps(meta, ensure_ascii=False, indent=2))
|
||||||
try:
|
try:
|
||||||
|
entry = {'url': url, 'resource_type': rtype, 'timestamp': ts, 'body_file': body_path, 'meta_file': str(output / meta_name), 'excerpt': excerpt, 'content_hash': content_hash}
|
||||||
with open(index_path, 'a', encoding='utf-8') as idx:
|
with open(index_path, 'a', encoding='utf-8') as idx:
|
||||||
idx.write(json.dumps({'url': url, 'resource_type': rtype, 'timestamp': ts, 'body_file': body_path, 'meta_file': str(output / meta_name), 'excerpt': excerpt}, ensure_ascii=False) + '\n')
|
idx.write(json.dumps(entry, ensure_ascii=False) + '\n')
|
||||||
|
# update in-memory index
|
||||||
|
if content_hash:
|
||||||
|
in_memory_index.setdefault(content_hash, []).append(entry)
|
||||||
except Exception:
|
except Exception:
|
||||||
pass
|
pass
|
||||||
|
|
||||||
@@ -290,6 +440,20 @@ async def run(args):
|
|||||||
except Exception:
|
except Exception:
|
||||||
pass
|
pass
|
||||||
|
|
||||||
|
# attempt autologin (form-based) if credentials provided
|
||||||
|
uname = args.username or os.getenv('STATDX_USERNAME')
|
||||||
|
pwd = args.password or os.getenv('STATDX_PASSWORD')
|
||||||
|
if uname and pwd:
|
||||||
|
try:
|
||||||
|
ok = await attempt_autologin(page, uname, pwd, args.post_login_selector)
|
||||||
|
try:
|
||||||
|
with open(output / '_debug_events.log', 'a', encoding='utf-8') as dbg:
|
||||||
|
dbg.write(f"{now_ts()}\tAUTOLOGIN_RESULT\t{ok}\n")
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
except Exception:
|
||||||
|
pass
|
||||||
|
|
||||||
# If interactive, let user log in; otherwise start capture immediately
|
# If interactive, let user log in; otherwise start capture immediately
|
||||||
if not args.no_prompt:
|
if not args.no_prompt:
|
||||||
print('When you have logged in in the opened browser, press Enter here to continue and capture...')
|
print('When you have logged in in the opened browser, press Enter here to continue and capture...')
|
||||||
@@ -325,6 +489,9 @@ def parse_args():
|
|||||||
parser.add_argument('--headless', action='store_true')
|
parser.add_argument('--headless', action='store_true')
|
||||||
parser.add_argument('--continuous', action='store_true')
|
parser.add_argument('--continuous', action='store_true')
|
||||||
parser.add_argument('--no-prompt', action='store_true')
|
parser.add_argument('--no-prompt', action='store_true')
|
||||||
|
parser.add_argument('--username', help='STATdx username (or use STATDX_USERNAME env var)')
|
||||||
|
parser.add_argument('--password', help='STATdx password (or use STATDX_PASSWORD env var)')
|
||||||
|
parser.add_argument('--post-login-selector', default='#ds-app', help='Selector that indicates a successful login')
|
||||||
parser.add_argument('--channel', default=os.getenv('PLAYWRIGHT_CHROME_CHANNEL', 'chrome'))
|
parser.add_argument('--channel', default=os.getenv('PLAYWRIGHT_CHROME_CHANNEL', 'chrome'))
|
||||||
parser.add_argument('--capture-types', default='xhr,fetch,document,other')
|
parser.add_argument('--capture-types', default='xhr,fetch,document,other')
|
||||||
return parser.parse_args()
|
return parser.parse_args()
|
||||||
|
|||||||
Reference in New Issue
Block a user