title: A giant adrenal pseudocyst presenting with right hypochondralgia and fever: a case report.
abstract: BACKGROUND
  Adrenal pseudocysts are rare cystic masses that arise from the adrenal gland and which are usually non-functional and asymptomatic. Adrenal pseudocysts consist of a fibrous wall without an epithelial or endothelial lining. We report the case of a patient with a giant adrenal pseudocyst presenting with right hypochondralgia and high fever.
  
  
  METHODS
  A 52-year-old Japanese man was admitted with right hypochondralgia and a chill. Abdominal computed tomography revealed a well-defined cystic mass measuring 19 cm which was located in the right adrenal region and the contents of which were not enhanced with contrast medium. Abdominal ultrasonography revealed a heterogeneously hypo-echoic lesion with a peripheral high-echoic rim. Serum hormonal levels were almost normal. Despite treatment with antibiotics, the high fever persisted. Based on these findings, we made a preoperative diagnosis of a right adrenal cyst with infection. However, the possibility of malignancy still remained. The patient underwent laparotomy and right adrenal cyst excision with partial hepatectomy in order to relieve the symptoms and to confirm an accurate diagnosis. Histological examination revealed an adrenal pseudocyst with infection. His condition improved soon after the operation.
  
  
  CONCLUSIONS
  We report a case of a giant adrenal pseudocyst with infection. Surgery is required for symptomatic cases in order to relieve the symptoms and in cases of uncertain diagnosis.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan. mmomiyama@hotmail.com.
authors.forename: Masashi
authors.initials: M
authors.lastname: Momiyama
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.forename: Shoji
authors.initials: S
authors.lastname: Yamanaka
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo