RADIOLOGY: ADRENAL: Case# 32904: ADRENAL TB. 50 year old male with fever and cough. Left pleural effusion noted on chest radiograph. Dense airspace consolidation is identified in the entire left upper and lower lobe with several punctate calcifications. In addition, a large loculated pleural effusion is identified in the left with thick visceral and parietal pleura with multiple calcifications. Large adrenal masses, left greater than right, with punctate calcifications are identified. Granulomatous disease of the adrenals, such as tuberculosis or sarcoidosis, causes diffuse bilateral enlargement of the glands with low density areas of caseous necrosis or diffuse calcification. Active tuberculosis may be present without lung disease. Hence, a patient with enlarged adrenal glands and a positive tuberculin skin test should be considered to have active tuberculosis.