Presentation
Right loin pain and hypertension
Patient Data
A large well defined right suprarenal mass lesion that is separated from the liver by a rim of fat is seen (best appreciated in portovenous phase). The lesion demonstrates heterogeneous contrast enhancement with areas of cystic changes/necrosis. It is of note that the lesion tends to enhance more during the portovenous phase with retained contrast during the delayed phase.
The rest of the scan was unremarkable.
Giving the radiological appearance and clinical presentation of uncontrolled hypertension pheochromocytoma is the best fitting diagnosis.
Case Discussion
Pheochromocytoma tends to be large at presentation and usually measures > 3cm. CT appearance usually of heterogeneous enhancement with areas of necrosis/cystic degenerations. Pheochromocytoma also tends to enhance more during the portovenous phase compared to the arterial phase.
MRI appearance shows the pathognomonic light bulb sign in T2 weighted image sequence.
The presence of a clinical history of uncontrolled hypertension and urinary catecholamines eliminates other differentials.
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