From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation.

Advanced imaging often reveals adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients. When adrenal disease is clinically suspected, cross-sectional imaging can be helpful in evaluating the etiology of the patient's symptoms. When adrenal disease is incidentally identified, what the clinician and patient really want to know is whether the findings are benign or malignant, as this ultimately will affect their next step in management. Using radiologic-pathologic correlation, we broadly classify common, uncommon, and rare tumors and tumor-like conditions that can occur in the adrenal as benign or malignant. This classification follows predominant trends in observed biologic behavior while acknowledging those tumors that may behave in the minority in an unpredictable manner. We review the clinical background and presentation of functional adrenal tumors including Conn syndrome, Cushing syndrome, and catecholamine-secreting tumors, as well as their relationship with adrenal anatomy. We discuss a variety of benign tumors, including adrenal cortical adenoma (including oncocytoma) and pheochromocytoma, as well as uncommonly and rarely encountered tumors such as myelolipoma, hemangioma, lymphangioma, schwannoma, ganglioneuroma, and adenomatoid tumor. A variety of tumefactive but nonneoplastic lesions are addressed, including adrenal cortical hyperplasia, adrenal hemorrhage, adrenal cysts, and infections. Malignant tumors discussed include adrenal cortical carcinoma, the rare malignant pheochromocytoma, lymphoma, metastases, and sarcomas. For each tumor and tumor-like lesion, the clinical presentation, epidemiology, key imaging findings, diagnostic differential considerations, and management options are briefly addressed. Finally, an approach to the workup of suspected or incidentally discovered tumors is presented based on a selected literature survey and our clinical experience. Radiologists play an important role in identification and diagnosis of adrenal tumors and tumor-like conditions in both symptomatic and asymptomatic patients.

The "floating" meniscus: MRI in knee trauma and implications for surgery.

OBJECTIVE: We describe 21 cases involving meniscal injury in which the meniscus appears free-floating on MRI of the knee. In these cases, the meniscus is completely surrounded by fluid. Correlation with surgical reports shows that the "floating" meniscus corresponds to a meniscal avulsion or detachment from the tibial plateau with an associated disruption of the meniscotibial coronary ligaments, which attach the meniscus to the tibia, allowing fluid to encompass the meniscus. A floating meniscus on MRI may represent a new specific finding for an uncommon form of meniscal injury known as meniscal avulsion. CONCLUSION: The presence of a floating meniscus on MRI is a result of significant trauma to the knee leading to meniscal avulsion and is often associated with significant ligamentous injury. Alerting the surgeon to the presence of a meniscal avulsion facilitates appropriate surgical planning with meniscal reattachment to the tibial plateau.