CTICasesDisseminated Adrenal Histoplasmosis
Imaging findings
Abdominal CT reveals massive, bilateral adrenal gland enlargement with heterogeneous low-attenuation areas, alongside splenomegaly, low-attenuation hepatic lesions, and ascites. The chest CT and radiographs are relatively unremarkable, with only mild, non-specific basal changes or scarring and mild mediastinal adenopathy.
Key takeaways
Fine needle biopsy of the adrenal masses confirmed histoplasmosis. Adrenal involvement is a classic presentation of disseminated histoplasmosis, particularly in older patients or immunocompromised hosts, and is a well-known cause of adrenal insufficiency and subsequent calcification. Disseminated histoplasmosis can present as massive bilateral adrenal enlargement mimicking metastatic disease, lymphoma, or tuberculosis, often in the absence of prominent active pulmonary disease.
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