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A 43-year-old man with no significant medical history had a 3-month history of right upper quadrant pain with no associated gastrointestinal or urinary symptoms. On examination, he appeared well and was in no distress. His abdomen was not tender, but had a palpable right upper quadrant fullness. A computed tomographic (CT) scan revealed a 7.9-cm, bilobed, fat-containing mass adjacent to the upper pole of the right kidney (Figure 1). A magnetic resonance image (MRI) was performed to better assess its continuity with adjacent organ structures. It showed no hepatic or renal invasion (Figure 2).
Computed tomographic scan identifying calcifications in the right adrenal gland and a 7.9-cm bilobed mass bordered by the liver (laterally), upper pole of the right kidney (inferiorly and posteriorly), vena cava (medially), and the right colon (anteriorly).
Magnetic resonance image showing a bilobed, smoothly marginated, fat signal intensity, right upper quadrant mass located in the Morrison pouch, likely arising from the right adrenal gland.
A. Adrenal carcinoma
C. Adrenal myelolipoma
D. Adrenal adenoma
Connor L, Craig J, Buch KE, Divino CM. Image of the Month—Quiz Case. Arch Surg. 2009;144(3):283-284. doi:10.1001/archsurg.2008.583-a