title: Gastric diverticulum simulating left adrenal incidentaloma in a hypertensive patient.
abstract: A 46-year-old Japanese male with hypertension was referred for examination of left adrenal tumor incidentally detected by computed tomography (CT) scan. The patient had a 4-month history of hypertension. Abdominal CT demonstrated a low-density mass 2.5 cm in diameter in the left adrenal region that was observed as a high-intense lesion with T2-weighted magnetic resonance imaging. (131) I-adosterol scintigraphy showed normal uptake of bilateral adrenals. The adrenocortical hormone levels were within normal ranges; however, urinary noradrenaline excretion was slightly elevated, likely due to concurrent sleep apnea syndrome. Based on the observation of a very tiny bubble in the ventral portion of the adrenal mass by careful review of CT images examined at a previous hospital, a restudy of abdominal CT with oral contrast was performed. In this restudy abdominal CT we observed positive enhancement of the left adrenal mass, indicating that the adrenal mass was a diverticulum derived from posterior gastric fornix. The present case study reinforces that preoperative differentiation from mimic adrenal tumors is necessary in cases of cystic adrenal mass in the left adrenal region.
authors.affiliation: Department of Medicine and Clinical Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kodera
authors.forename: Fumio
authors.initials: F
authors.lastname: Otsuka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Inagaki
authors.forename: Tomoko
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Toshio
authors.initials: T
authors.lastname: Ogura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tanimoto
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sei
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D000324:Adrenocorticotropic Hormone / Q000097:blood; D003937:Diagnosis, Differential; D013273:Diverticulum, Stomach / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000652:urine; D014057:Tomography, X-Ray Computed
chemical_list: D000324:Adrenocorticotropic Hormone; D009638:Norepinephrine