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Case 101

Adrenal cyst

Incidental RUQ mass

Imad Mutasim Azouka

The patient is a middle aged asian male complaining of episodes of increased blood pressure, who came for ultrasound examination. This showed incidentally a large cystic mass with well defined walls just superior to the upper pole of the right kidney. CT scan was advised to further assess the lesion.

Findings

There is evidence of a large near-water density rounded well defined mass arising from the right suprarenal gland region measuring about 12 x 11.5 cm. The mass is causing antero-medial displacement of the inferior vena cava as well as the right kidney inferiorly. It is extending into the inferior aspect of the right lobe of liver at the same time. A small focal calcification is noted in its rim with no significant enhancment after dynamic bolus I/V contrast.

Diagnosis

Adrenal cyst

Differential

1 - Necrotizing tumour
2 - Adenoma

Discussion

Adrenal cysts are a very rare finding, encountered in females more than males, typically 30-60 years of age. Female to male ratio 2:1. They are usually endothelial type of cysts (45%), showing well defined smooth walls, nonenhancing after iv contrast. The other type (40%) is a pseudocyst, with a thick wall of fibrous tissue with mural calcifications; they mostly arise from haemorrahge or infarction of the adrenal gland. The less common type is parasitic (10%), mosly hydatid. Other forms of adrenal cysts are epithelial, about 5%.

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