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Special Feature
March 16, 2009

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Department of Surgery, The Mount Sinai School of Medicine, New York, New York.




Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Surg. 2009;144(3):283-284. doi:10.1001/archsurg.2008.583-a

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).

Figure 1.
Image not available

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).

Figure 2.
Image not available

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.

What Is the Diagnosis?

A. Adrenal carcinoma

B. Teratoma

C. Adrenal myelolipoma

D. Adrenal adenoma