Images in Surgery| Volume 147, ISSUE 4, P591-593, April 2010

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An adrenal mass

Published:February 02, 2009DOI:
      This section features outstanding photographs of clinical materials selected for their educational value or message, or possibly their rarity. The images are accompanied by brief case reports (limit 2 typed pages, 4 references). Our readers are invited to sumit items for consideration.
      A 71-year-old man presented for elective proctocolectomy for ulcerative colitis. A prior colonoscopy had revealed normal terminal ileum but ulceration of the colon was observed with acute and chronic inflammation, cryptitis, crypt abscesses, architectural distortion, and gland dropout consistent with chronic ulcerative colitis. Despite administration of prednisone and 6-mercaptopurine, he developed fevers, hematochezia, and abdominal pain. Abdominal computed tomography (CT) revealed a unilateral, complex, noncalcified, partially necrotic, low-density adrenal mass with septations that enhanced with intravenous contrast (Fig 1). The patient underwent proctocolectomy, end ileostomy, and left adrenalectomy. Biopsy was also performed of multiple 1- to 3-mm nodules observed to be studding the peritoneal cavity.
      Figure thumbnail gr1
      Fig 1Infused CT of the patient's abdomen showed a large left-sided abdominal mass.
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