Alessandro Zotti

Background The contrast‐enhanced ultrasound (CEUS) features of adrenal lesions are poorly reported in veterinary literature. Methods Qualitative and quantitative B‐mode ultrasound and CEUS features of 186 benign (adenoma) and malignant (adenocarcinoma and pheochromocytoma) adrenal lesions were evaluated. Results Adenocarcinomas ( n = 72) and pheochromocytomas ( n = 32) had mixed echogenicity with B‐mode, and a non‐homogeneous aspect with a diffused or peripheral enhancement pattern, hypoperfused areas, intralesional microcirculation and non‐homogeneous wash‐out with CEUS. Adenomas ( n = 82) had mixed echogenicity, isoechogenicity or hypoechogenicity with B‐mode, and a homogeneous or non‐homogeneous aspect with a diffused enhancement pattern, hypoperfused areas, intralesional microcirculation and homogeneous wash‐out with CEUS. With CEUS, a non‐homogeneous aspect and the presence of hypoperfused areas and intralesional microcirculation can be used to distinguish between malignant (adenocarcinoma and pheochromocytoma) and benign (adenoma) adrenal lesions. Limitations Lesions were characterised only by means of cytology. Conclusions CEUS examination is a valuable tool for distinction between benign and malignant adrenal lesions and can potentially differentiate pheochromocytomas from adenocarcinomas and adenomas. However, cytology and histology are necessary to obtain the final diagnosis.