Introduction: Adrenal vascular cysts are rare, in most cases incidentally discovered during abdominal imaging for other reasons. We present a case of adrenal endovascular cyst with initial suspicious features of adrenal malignancy and subsequent management and complications.
Case report: This 72-year-old male was initially admitted with a weight loss over 2 months and new onset fever and rigors and right leg pain. He was noted to have an abdominal mass. He was treated along the lines of urosepsis and an ultrasound Doppler of his leg showed femoral and popliteal aneurysms and ultrasound of his abdomen revealed a large heterogeneous right-sided adrenal mass of 25 cm.
He had a past history of well-controlled hypertension. Hormonal workup revealed normal adrenal reserve and normal levels of serum aldosterone, renin and metanephrines. A CT scan confirmed the adrenal mass with displacement of the liver and some IVC compression and this had increased in size significantly from 6 cm, 5 years ago. The patient was referred to a tertiary centre for further management. He presented 2 weeks later with severe abdominal pain and hypotension. A repeat CT scan showed evidence of rupture of the mass with bleeding into the peritoneum and also haemorrhage into the mass. He was empirically treated with steroids and transferred to the tertiary centre for emergency surgery and mass removal. Histology subsequently revealed haemorrhage and necrosis from rupture of a large adrenal pseudo cyst with negative immunohistochemistry for necrotic tumour cell population but with a presence of a focal vascular lining suggesting an adrenal endothelial cyst.
Conclusion: Rare adrenal vascular cysts should be considered in the differential of adrenal masses. Prompt surgical removal after appropriate imaging and hormonal assessments can avoid complications such as rupture and bleeding.