Retroperitoneal varices presenting as an adrenal pseudotumor in a cirrhotic patient.
Herein is reported a case of a putative tumor of the left adrenal gland found incidentally during the workup of a cirrhotic patient with portal hypertension. This mass manifested vascular enhancement and other features of an adenoma both on computed tomography (CT) and magnetic resonance imaging (MRI) scans. Additional workup revealed elevated salivary cortisol and plasma aldosterone levels. A proposed biopsy of this mass was deferred because of an episode of variceal bleeding that required placement of a transjugular intrahepatic portosystemic shunt (TIPS). Post TIPS placement, repeat CT and MRI scans showed that the mass had disappeared, indicating that this pseudotumor was, in fact, a knot of peri-adrenal varices, which was now decompressed. In this report, the anatomic and pathologic basis of peri-adrenal varices in a patient with portal hypertension is discussed, as well as the ability of current imaging studies at establishing this diagnosis. Liver disease may cause abnormalities in endocrine function, which make this diagnosis difficult.
Paramesh
Anil S
AS
St. Luke's Medical Center, Aurora Health Care, 2801 W Oklahoma Ave, Ste 511, Milwaukee, WI 53215, USA. anil.paramesh@aurora.org
Meiners
Ryan
R
Fairchild
Ralph B
RB
Sane
Shekar
S
George
Magdalene
M
Van Thiel
David H
DH
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply*; D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012187:Retroperitoneal Space; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis*