Presentation
Abdominal pain.
Patient Data
Small umbilical hernia containing omental fat. There is a small amount of fat stranding in the fat just subjacent to the hernia. No bowel demonstrated within the hernia. There is a small fat-containing inguinal hernia bilaterally. Fatty infiltration of the liver.
Ovoid 2.5 x 2.5 x 2.5 cm low-density lesion (8-15HU) arising from the lateral limb of the right adrenal gland is probably an adrenal adenoma (the study was only obtained in portal vein phase). The left adrenal gland is normal. The remainder study is unremarkable.
The incidental low-density right adrenal lesion is most likely an adenoma. This scan was a portal venous phase-only acquisition. The patient presented 3 years later in the ED complaining of abdominal pain (next study).
The low-density lesion previously seen arising from the lateral limb of the right adrenal gland has increased in size now measuring up to 5.7 x 4.8 x 4.5 cm. The density has only slightly increased now measuring approximately 17 HU (Again, this is a portal venous phase study). Further assessment with adrenal washout CT is recommended to confirm suspected (benign) cystic nature of the lesion.
Pre, postcontrast, and delayed images have been obtained through the upper abdomen and compared with the study performed one month ago.
The 5.7 cm right adrenal lesion has a Hounsfield unit of 18 pre-contrast imaging with no discernible enhancement seen on post-contrast images (HU 20 at 60 seconds and HU 18 at 15-minute delay. Dependant sludge is seen in the gallbladder. The remainder of the imaged abdominal viscera is unchanged to previous.
The right adrenal cystic lesion measures 6 x 5 x 5 cm. The right kidney appears normal.
Case Discussion
The features, especially the last dedicated CT and ultrasound, are those of a non-enhancing right adrenal cyst.
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