The Case ∣ A hypertensive woman with an abnormal abdominal X-ray

Abstract

A 52-year-old woman was evaluated for right flank discomfort for 2 months and for newly developed hypertension. She had experienced a motor scooter accident with blunt trauma to her right flank 3 years ago. Her family history was unremarkable. On physical examination, her blood pressure was 162/98 mm Hg and pulse rate was 74 per minute. A palpable firm mass over the right costovertebral angle was noted without percussion tenderness. The remainder of her physical examination was unrevealing. Urinalysis revealed mild proteinuria (1+) without hematuria or pyuria. Laboratory investigations were notable for mild anemia (hemoglobin 11.2 g per 100 ml), hypokalemia (potassium 3.2 mmol/l), high plasma activity of renin (2.3, 0.2–0.7 ng/l/sec) and aldosterone (714.9, 98.9–664.8 mmol/l). Abdominal plain film showed an unexpected huge opaque mass around the right flank region (Figure 1). The use of enalapril (20 mg daily) led to a reduction of blood pressure to 130/80 mm Hg on average.