Presentation
Abdominal pain and swelling right lower quadrant. Tuberculosis 30 years earlier. On regular steroid therapy.
Patient Data
As well as cholecystectomy clips, there are rounded calcified masses in the paravertebral regions bilaterally.
The CT confirms the presence of bilateral calcified and bulky adrenal glands, correlating with the abdominal x-ray findings. In the right lower quadrant, there is an abdominal wall hernia containing omental fat and small bowel. The neck is wide and there is no bowel obstruction. The hernia is just lateral to the lateral border of the right rectus abdominis muscle and is a Spigelian hernia.
Case Discussion
Previous tuberculosis infection of the adrenal glands left the patient with Addison disease and requiring lifelong steroid replacement therapy. The other main differential for such adrenal calcification is adrenal hemorrhage.
The pain and swelling were due to the Spigelian hernia. When surgery is considered in patients with Addison's disease, close attention should be paid to post-operative steroid replacement as the stress of surgery necessitates a change in steroid dose to prevent an Addisonian crisis.
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