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02 June 2015 : Case report  USA

All Those Liver Masses are not Necessarily from the Liver: A Case of a Giant Adrenal Pseudocyst Mimicking a Hepatic Cyst

Unusual clinical course, Mistake in diagnosis, Diagnostic / therapeutic accidents

Soumya PatnaikE, Alvin HtutE, Peter WangE, Daniel EisenbergE, Ronald MiickE, Eyob FeyssaE

DOI: 10.12659/AJCR.893798

Am J Case Rep 2015; 16:333-337

Abstract

BACKGROUND: Most abdominal cysts, including adrenal pseudocysts, are benign and asymptomatic. Rapid enlargement, hemorrhage, infection, rupture with leakage of cyst contents, or pressure on adjacent organs can cause symptoms. Although usually diagnosed incidentally on imaging, determining the origin of a cyst can sometimes be challenging. In these situations, surgical excision and pathological analysis is crucial to diagnosis and management. We report here a case of a giant symptomatic adrenal pseudocyst that closely mimicked a hepatic cyst at presentation.

CASE REPORT: A 50-year-old man, with a history of an incidentally detected hepatic cyst, presented with severe abdominal pain, fevers, leukocytosis, and mildly abnormal liver function tests. CT scan revealed a large well defined cystic space-occupying lesion within the liver, with findings suggesting cyst rupture and possible infection. Early laparotomy was performed, and the origin was determined intraoperatively to be right adrenal, which was later confirmed by pathology.

CONCLUSIONS: Contrast-enhanced CT scan is the criterion standard for evaluation for abdominal cystic masses. Precise diagnosis of a giant abdominal cyst can be challenging. Surgery is both diagnostic and curative in such situations. We also discuss the specific situations in which surgery should be considered in cases of adrenal cystic masses.

Keywords: Adrenalectomy - methods, Adrenal Gland Diseases - surgery, Biopsy, Cysts - surgery, Diagnosis, Differential, Liver Diseases - diagnosis, Tomography, X-Ray Computed - methods

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923