Presentation
Patient presented to the emergency department with upper abdominal pain.
Patient Data
A non-enhancing hypoattenuating lesion with peripheral wall calcifications without internal septations or fatty component seen in the left upper abdomen measuring about 11 x 10.5 x 12 cm (AP, RL, CC) suggests a cystic lesion, causing mass effect on adjacent small bowel and organs, pushing the left kidney inferomedially.
It appears to be abutting the left adrenal gland.
No claw sign is seen with the left kidney, pancreas, or spleen.
Based on radiological features alone; differential diagnoses include an adrenal cystic lesion such as a hemorrhagic pseudocyst versus a retroperitoneal cystic lesion (such as a non-pancreatic pseudocyst, hydatid cyst, lymphangioma).
Ultrasound of the same patient showed a thick-walled cyst with internal debris and leveling.
It appears separate from the left kidney and spleen.
Case Discussion
This lesion was proven surgically to be of an adrenal origin and was sent for biopsy, which showed an adrenal pseudocyst.
Pathology report as follows:
GROSS:
Specimen fixed labeled with patient's name, consists of 53.5 gm, 8 x 8.5 x 3.5 cm grey-white, a previously-opened cyst. Sectioning reveals multiple variably-sized, yellowish nodules. Submitted in 5 cassettes, left tissue.
MICROSCOPIC:
Sections reveal adrenal gland with cystic lesion showing partially-calcified, fibrous wall, with many nodules showing cholesterol-clefts and hemosiderin deposition. No malignancy seen in the levels examined.
DIAGNOSIS:
Left adrenal gland cyst, resection:
Adrenal cyst, with features suggestive of hemorrhagic/pseudocyst.
Unable to process the form. Check for errors and try again.