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( Adrenal lesion )
S.A. Rooholamini, M.D.*, C. Aoyama, M.D.†,
A.H. Au, M.D.*, J. Rahimian, Ph.D.*,
From the Departments of Radiological Sciences* and Pathology† Olive View-UCLA Medical Center, Sylmar, CA
CASE SUMMARY The patient is a 56-year-old man with left flank pain of one-month duration. The patient complains that he cannot bend to his left. He reports no headaches, palpitations, weight loss, or change in bowel habits. Physical examination revealed left flank fullness. The laboratory values, including 24-hour urinary VMA and metanephrine, are normal.
Figure 1. (A and B) Axial CT images of the abdomen at the level of the adrenal glands without (A) and with (B) contrast enhancement demonstrate a large bilobed space-occupying mass in the left adrenal bed.
Figure 2. (A, B, C and D) A large heterogeneous mass is present in the left adrenal bed containing fat and soft tissue densities and displacing the adjacent structures. The mass measures 16x9x11 cm. No significant enhancement is noted following intravenous administration of contrast material.
RADIOLOGIC FINDINGS Computed tomography of the abdomen reveals a large tumor in the left side of the abdomen posterior to the stomach and pancreas and medial to the spleen. The mass is bilobed and measures 16x9x11 cm, indents the stomach posteriorly and displaces it anteriorly. The mass compresses and displaces the pancreas anteriorly and the left kidney caudad. The splenic artery and vein are stretched and displaced anteriorly by the mass. The jejunal loops are also displaced anteromedially. The mass has a heterogeneous appearance containing fat and soft tissue densities. No calcifications are visible within the mass. The mass is rather well delineated and no stranding is visible around it. The right adrenal gland is seen and is normal. A normal left adrenal gland cannot be identified. The right kidney is normal. The left kidney is displaced inferiorly by the mass. Both kidneys demonstrate normal function. Following intravenous administration of contrast material, minimal enhancement of the soft tissue components of the mass occurs. There is no significant difference between the early and the late phases. There is no evidence for retroperitoneal lymphadenopathy or ascites.
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