Abstract
IntroductionAdrenal pseudocysts are rare cystic masses that arise from the adrenal gland and which are usually non-functional and asymptomatic. Adrenal pseudocysts consist of a fibrous wall without an epithelial or endothelial lining. We report the case of a patient with a giant adrenal pseudocyst presenting with right hypochondralgia and high fever.Case presentationA 52-year-old Japanese man was admitted with right hypochondralgia and a chill. Abdominal computed tomography revealed a well-defined cystic mass measuring 19 cm which was located in the right adrenal region and the contents of which were not enhanced with contrast medium. Abdominal ultrasonography revealed a heterogeneously hypo-echoic lesion with a peripheral high-echoic rim. Serum hormonal levels were almost normal. Despite treatment with antibiotics, the high fever persisted. Based on these findings, we made a preoperative diagnosis of a right adrenal cyst with infection. However, the possibility of malignancy still remained. The patient underwent laparotomy and right adrenal cyst excision with partial hepatectomy in order to relieve the symptoms and to confirm an accurate diagnosis. Histological examination revealed an adrenal pseudocyst with infection. His condition improved soon after the operation.ConclusionWe report a case of a giant adrenal pseudocyst with infection. Surgery is required for symptomatic cases in order to relieve the symptoms and in cases of uncertain diagnosis.
Highlights
Adrenal pseudocysts are rare cystic masses that arise from the adrenal gland and which are usually non-functional and asymptomatic
We report a case of a giant adrenal pseudocyst with infection
We report a case of giant adrenal pseudocyst presenting with a right hypochondralgia and high fever, which was diagnosed as an adrenal pseudocyst with infection measuring about 19 cm in largest diameter
Summary
In 1903, Doran attributed the first case of adrenal cyst to Greiselius [1]. In 1670, he described a 45-year-old man whose death resulted from a rupture of the cyst. Case presentation A 52-year-old Japanese man, who had an intra-abdominal cystic mass, was followed up every year in another hospital His previous ultrasonography (US) which was performed seven years ago, revealed a unilobulated cyst, measuring 14 cm in diameter, adjacent to the liver. An enhanced computed tomography (CT) of the abdomen revealed a giant homogeneous low density mass lesion in the right adrenal region indenting over the inferior aspect of the right lobe of the liver, displacing the inferior vena cava with no abdominal lymphadenopathy (Figure 2a). The cyst was found to be densely adhered to the posterior abdominal wall, the liver, the inferior vena cava and the right kidney. It was resected concomitant with partial hepatectomy. The right hypochondralgia and high fever resolved after the removal of the pseudocyst
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