A Huge Adrenal Hematoma in an Adrenal Cavernous Hemangioma Manifesting as a Chronic Expanding Hematoma of the Retroperitoneum: A Case Report

Abstract

This report presents the case of a huge chronic expanding hematoma in the right adrenal gland. A 66-year-old Japanese woman was referred for the evaluation of a huge mass in the middle of her abdomen. Her physical condition was unremarkable except for bilateral edema of the lower extremities. She had undergone hysterectomy and left oophorectomy due to uterine leiomyoma 18 years earlier, but her medical history had included neither anticoagulant therapy nor abdominal trauma. The laboratory data revealed anemia but showed that all tumor markers were within normal range. In the right abdomen, abdominal computed tomography (CT) demonstrated a well-demarcated, 35-cm mass compressing the surrounding organs to the left side. The peripheral region of the mass was slightly enhanced, and the central part was hypovascular, indicating central necrosis or hematoma. No right adrenal gland was identified. Magnetic resonance imaging showed that the inner aspect of the mass appeared to be unequally hyperintense on T1-and T2-weighted images. The rim of the mass was hypointense on the T2-weighted image but hyperintense on diffusion-weighted images. Abdominal CT angiography indicated that the right capsular branches of the right renal artery and right inferior phrenic artery were feeding arteries for the mass. The preop-