Do Kidney Ultrasounds Evaluate the Adrenal Glands?
Kidney ultrasounds do not routinely or reliably visualize the adrenal glands, and ultrasound is rated as inappropriate (rating of 2 out of 9) for adrenal gland evaluation according to the American College of Radiology. 1
Why Ultrasound is Limited for Adrenal Imaging
The adrenal glands are located superior to the kidneys but are technically challenging to visualize with standard renal ultrasound due to:
- Lack of satisfactory acoustic windows through which the ultrasound beam can pass 2
- Operator-dependent limitations requiring meticulous scanning techniques and significant experience 2
- Anatomical positioning that makes consistent visualization difficult during routine renal examinations 3
Visualization Rates in Clinical Practice
When specifically attempting to image the adrenal glands with transabdominal ultrasound:
- Right adrenal gland: Can be visualized in approximately 99% of cases when specifically sought 3
- Left adrenal gland: Successfully visualized in only 69% of cases with transabdominal approach 3
- Standard renal ultrasound protocols: Do not include systematic adrenal gland assessment 1
What Renal Ultrasound Actually Evaluates
Emergency and routine renal ultrasound examinations focus on:
- Hydronephrosis (obstruction of the urinary collecting system) 1, 4
- Kidney size and echogenicity (indicators of chronic kidney disease) 1, 4
- Renal stones (though stones <3mm are usually not identified) 1
- Bladder assessment for urinary retention 1
- Perirenal fluid in trauma settings 1
Appropriate Imaging for Adrenal Evaluation
When adrenal pathology needs assessment, the recommended imaging modalities are:
- Non-contrast CT as first-line (rating 8/9) for characterizing adrenal masses 1, 5
- Chemical shift MRI (rating 8/9) when lesions are found only on contrast-enhanced CT 1, 5
- Ultrasound of adrenal glands receives the lowest appropriateness rating (2/9) 1
Clinical Implications
- Incidental adrenal findings: If an adrenal mass >1cm is incidentally detected on any imaging, CT or MRI should be performed for proper characterization 6
- Renal cancer staging: While RCC can metastasize to the adrenal gland 1, standard renal ultrasound is not adequate for adrenal assessment
- Each abdominal ultrasound should include assessment of suprarenal areas according to Polish Ultrasound Society recommendations, but this requires specific technique beyond routine renal imaging 6
Common Pitfall
Do not assume that a "normal" renal ultrasound has excluded adrenal pathology—the adrenal glands are simply not reliably evaluated during standard renal ultrasonography. 1, 2 If adrenal disease is suspected clinically, dedicated cross-sectional imaging with CT or MRI must be obtained. 1, 5