title: All Those Liver Masses are not Necessarily from the Liver: A Case of a Giant Adrenal Pseudocyst Mimicking a Hepatic Cyst.
abstract: BACKGROUND
  Most abdominal cysts, including adrenal pseudocysts, are benign and asymptomatic. Rapid enlargement, hemorrhage, infection, rupture with leakage of cyst contents, or pressure on adjacent organs can cause symptoms. Although usually diagnosed incidentally on imaging, determining the origin of a cyst can sometimes be challenging. In these situations, surgical excision and pathological analysis is crucial to diagnosis and management. We report here a case of a giant symptomatic adrenal pseudocyst that closely mimicked a hepatic cyst at presentation.
  
  
  METHODS
  A 50-year-old man, with a history of an incidentally detected hepatic cyst, presented with severe abdominal pain, fevers, leukocytosis, and mildly abnormal liver function tests. CT scan revealed a large well defined cystic space-occupying lesion within the liver, with findings suggesting cyst rupture and possible infection. Early laparotomy was performed, and the origin was determined intraoperatively to be right adrenal, which was later confirmed by pathology.
  
  
  CONCLUSIONS
  Contrast-enhanced CT scan is the criterion standard for evaluation for abdominal cystic masses. Precise diagnosis of a giant abdominal cyst can be challenging. Surgery is both diagnostic and curative in such situations. We also discuss the specific situations in which surgery should be considered in cases of adrenal cystic masses.
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Soumya
authors.initials: S
authors.lastname: Patnaik
authors.affiliation: Department of Medicine, Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Alvin
authors.initials: A
authors.lastname: Htut
authors.affiliation: Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eisenberg
authors.affiliation: Department of Medicine, Division of Hepatology, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Miick
authors.affiliation: Department of Medicine, Division of Hepatology, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Eyob
authors.initials: E
authors.lastname: Feyssa
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis* / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D001706:Biopsy; D003560:Cysts / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*