Presentation
Right-sided abdominal pain; suspected gallbladder stone disease. History of sleeve gastrectomy.
Patient Data
There is a large well-defined homogeneous bright mass lesion seen in the right suprarenal area measuring about 12 X 11 cm with no central necrosis or gross internal vascularity, making mass effect on the upper pole of right kidney.
The liver is average in size, homogeneous texture, no intrahepatic biliary radicles dilatation, no focal lesion is seen, PV is normal in diameter.
Gallbladder has thin wall, multiple variable-sized gallstones are seen, no pericholecystic fluid is seen. CBD and pancreas are normal.
Spleen is normal in size and texture.
Kidneys are normal in size, normal parenchymal echotexture, intact corticomedullary differentiation, no stones or hydronephrosis.
Bilateral fatty adrenal lesions are noted:
- the right one is large and well-defined with heterogeneous mixed fatty and soft tissue densities, no hemorrhage seen within the lesion or retroperitoneal, no calcification, the lesion measures about 11 x 12 cm in maximum dimensions, the lesion is totally separated from the right kidney with mass effect on the right kidney in form of downward displacement
- the left adrenal lesion is purely of fat density measuring about 4.5 x 2.5 cm
Non-cirrhotic liver with no focal lesion and portal vein is patent.
Gallbladder, intra- and extrahepatic biliary radicles are normal.
Pancreas, kidneys, stomach, spleen, small and large bowel are unremarkable.
No enlarged retroperitoneal lymph nodes or peritoneal deposits or free air or free fluid.
Impression:
Bilateral fatty adrenal lesions (bilateral adrenal myelolipomas).
Case Discussion
Features are highly suggestive of adrenal myelolipoma. Large size is risky for retroperitoneal hemorrhage.