History: 56 yo male with scrotal and lower extremity swelling.
Solution: Adrenal carcinoma
The imaging findings in this case show a very large mass essentially filling the left upper quadrant. Identifying the source can certainly be challenging. In this case, the kidney can be identified, displaced into the pelvis, thus suggesting a supra-renal origin of the mass. Also, the bowel is all pushed anteriorly and the spleen can be identified superiorly. In addition, there are coarse calcifications and heterogeneous attenuation, which may represent areas of necrosis and hemorrhage. In combination, these findings are suggestive of an adrenal carcinoma and percutaneous biopsy confirmed this diagnosis.
Adrenal carcinomas can be functioning or non-functioning. If they are functioning, they will usually present earlier with hormonal syndromes, such as Cushing, Conn, or virilization. If they are non-functioning, then they are usually quite large at presentation and present with mass effect symptoms.
Treatment is surgery and chemotherapy and prognosis is good with limited disease, but poor with more advanced disease.
The imaging findings in this case show a very large mass essentially filling the left upper quadrant. Identifying the source can certainly be challenging. In this case, the kidney can be identified, displaced into the pelvis, thus suggesting a supra-renal origin of the mass. Also, the bowel is all pushed anteriorly and the spleen can be identified superiorly. In addition, there are coarse calcifications and heterogeneous attenuation, which may represent areas of necrosis and hemorrhage. In combination, these findings are suggestive of an adrenal carcinoma and percutaneous biopsy confirmed this diagnosis.
Adrenal carcinomas can be functioning or non-functioning. If they are functioning, they will usually present earlier with hormonal syndromes, such as Cushing, Conn, or virilization. If they are non-functioning, then they are usually quite large at presentation and present with mass effect symptoms.
Treatment is surgery and chemotherapy and prognosis is good with limited disease, but poor with more advanced disease.
CT Images
