title: Adrenal histoplasmosis: clinical presentation and imaging features in nine cases.
abstract: BACKGROUND
  We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region.
  
  
  METHODS
  Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT) in six, and magnetic resonance imaging (MRI) in three showed suprarenal masses. CT-guided (in five) and US-guided (in four) biopsy and fine-needle aspiration cytology established a definite diagnosis. The work-up for malignancy and tuberculosis was negative.
  
  
  RESULTS
  On cross-sectional imaging, eight patients had bilateral adrenal masses and one had a unilateral adrenal mass. Imaging features were variable. All adrenal masses were hypoechoic on US, homogeneous in five, and heterogeneous in four patients. All adrenal masses were hypodense on CT, homogeneous in four, and heterogeneous in two. Heterogeneous enhancement was seen in three, homogeneous enhancement in two, and no enhancement in one patient. MRI in three patients showed that the masses were of variable signal intensity on all pulse sequences.
  
  
  CONCLUSIONS
  Our case series showed that adrenal histoplasmosis does occur in immunocompetent persons living in areas not endemic for the disease. The imaging features were variable.
authors: Department of Radiodiagnosis and Imaging, Christian Medical College and Hospital, Vellore 632004, Tamilnadu, India.
authors: N
authors: N
authors: Kumar
authors: S
authors: S
authors: Singh
authors: S
authors: S
authors: Govil
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis*; D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006660:Histoplasmosis / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies