An incidental finding behind adrenal incidentaloma.

Area of Science:

• Endocrinology
• Gastroenterology
• Radiology

Background:

• Adrenal incidentalomas can present with complex imaging features.
• Necrotic collections from pancreatitis may mimic adrenal masses on initial imaging.
• Differentiating these lesions is crucial for appropriate patient management.

Purpose of the Study:

• To report a case where a necrotic collection post-pancreatitis mimicked an adrenal mass.
• To emphasize the role of advanced imaging and multidisciplinary discussion in diagnosis.
• To highlight potential diagnostic challenges in adrenal imaging.

Main Methods:

• Case presentation of a 61-year-old male with abdominal pain and a suspected adrenal lesion.
• Utilized abdominal ultrasonography, contrast-enhanced CT, MRI, and PET/CT for lesion characterization.
• Performed CT-guided drainage and fluid analysis for definitive diagnosis.

Main Results:

• Initial imaging suggested an adrenocortical tumor, but hormonal evaluation was normal.
• MRI revealed inhomogeneous fluid collection with peripheral enhancement, and PET/CT showed minimal uptake.
• CT-guided drainage confirmed an acute necrotic collection secondary to focal pancreatitis.

Conclusions:

• Acute necrotic collections after pancreatitis can mimic adrenal masses, posing a diagnostic challenge.
• MRI offers superior characterization of complex adrenal lesions compared to CT.
• A multidisciplinary approach is essential for managing adrenal incidentalomas with equivocal imaging findings.