title: Bronchogenic cyst masquerading as an adrenal tumor: a case of mistaken identity.
abstract: OBJECTIVE
  To describe a patient with a bronchogenic cyst that was erroneously diagnosed as an adrenal tumor and the surgical management strategy to address the operative challenges.
  
  
  METHODS
  We summarize the clinical presentation, diagnostic workup, surgical management, and pathologic features of the study patient and review the pertinent literature.
  
  
  RESULTS
  In this report, we present the case of a 23-year-old woman who underwent retroperitoneoscopic exploration after imaging identified an enlarging left adrenal lesion. Preoperative biochemical testing confirmed that the mass was nonfunctional. No lesion was found after a thorough retroperitoneoscopic exploration under standard high insufflation pressure. Serendipitously, low-pressure inspection for hemostasis after failed exploration enabled discovery of an intradiaphragmatic mass that proved to be a bronchogenic cyst rather than an adrenal tumor. Not only was this a difficult operative dilemma, but it was also an unusual presentation for this tumor.
  
  
  CONCLUSIONS
  Discovery of a retroperitoneal or intradiaphragmatic bronchogenic cyst is a rare occurrence. The unusual location and tumor characteristics contributed to near surgical failure. The fortuitous surgical strategy of low-pressure inspection allowed visualization of the tumor for definitive resection.
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA. patrick.oneal2@va.gov
authors.forename: Patrick B
authors.initials: PB
authors.lastname: O'Neal
authors.forename: Francis D
authors.initials: FD
authors.lastname: Moore
authors.forename: Atul
authors.initials: A
authors.lastname: Gawande
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Cho
authors.forename: Emily E
authors.initials: EE
authors.lastname: King
authors.forename: Jacob
authors.initials: J
authors.lastname: Moalem
authors.forename: Daniel
authors.initials: D
authors.lastname: Ruan
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis*; D000328:Adult; D001994:Bronchogenic Cyst / Q000175:diagnosis*; D005260:Female; D006801:Humans; D055815:Young Adult