Giant adrenal pseudocyst: A rare diagnosis

Abstract

We present a rare case of giant adrenal pseudocyst as a cause of right upper quadrant (RUQ) pain and highlight the typical multimodality imaging features. The case demonstrates the imaging features associated with giant adrenal pseudocysts to aid accurate and timely diagnosis. Despite the rarity of these lesions they are important to consider as benign lesions can closely mimic malignant ones. Unenhanced and contrast-enhanced CT is the imaging of choice for adrenal cysts. However, MRI can provide more exquisite assessment of cystic, solid and enhancing components. Pseudocysts can be purely cystic, mixed or solid. Classically, adrenal pseudocysts are described as cystic lesions (of homogenous water density) with a fibrous wall and thin internal septations. Mural/septal calcification is commonly demonstrated due to haemorrhage, this is discernible from central/amorphous calcification seen in malignant disease. As in this case, pseudocysts can contain solid components or layering secondary to haemorrhage. The key to differentiating organised haematoma from tumour is the lack of enhancement. If serial imaging is undertaken in these patients rapid changes in the solid components may be seen reflecting resolving haematoma. Adrenal pseudocysts are rare and have a wide differential. Cystic adrenal lesions warrant multimodality assessment as their imaging features aid diagnosis and differentiation from malignant disease. We suggest that MRI plays a complimentary role to CT. CT is superior at demonstrating mural/septal calcification but MRI aids in determining cystic components and differentiating haemorrhage from tumour.

Adrenal Tumors in Young Adults: Case Reports and Literature Review

“…Imaging studies of adrenal tumors are assessed to distinguish between benign and malignant lesions [1,[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The radiologic protocols allow for the determination of adenomas with a high probability (in CT evaluation of initial density, tumor's morphology, a profile of contrast medium washout).…”

“…The incidence of adrenal cysts is below 0.2%, and shows a predilection for women [18]. They can be divided into pseudocysts (39%), endothelial cysts (45%), epithelial cysts (9%), or parasitic cysts (7%) [9,11]. Among endothelial cysts are lymphangiomas, which constitute 0.06% of all adrenal tumors.…”

“…Although CT and MRI can successfully determine the character of the tumor, these tests are usually not sufficient to make a final diagnosis. It should be emphasized that occasionally PHEO, adrenal metastases, and primary adrenal lymphoma may appear as cystic lesions, and, thus, should be considered in differential diagnosis [9][10][11].…”

“…The vast majority of adrenal tumors (approximately 80%) are adrenocortical adenomas, hypertrophy, or nodular adrenocortical hyperplasia. Other lesions include pheochromocytomas (PHEO) (3-6%), adrenocortical carcinomas (ACC) (2-5%), adrenal metastases (1-2%), mesenchymal tumors (myelolipoma, lipomas, hemangiomas, sarcomas), lymphomas, cysts, ganglioneuromas [1][2][3][4][6][7][8][9][10][11][12][13][14], other rare tumors [15], or collision tumors consisting of at least two different histopathological types [7,16].…”

“…sarcomas), lymphomas, cysts, ganglioneuromas [1][2][3][4][6][7][8][9][10][11][12][13][14], other rare tumors [15], or collision tumors consisting of at least two different histopathological types [7,16].…”