Key result
Multimodal imaging including ultrasound, CT, and MRI identified a suspicious gall bladder lesion and a large atypical left adrenal incidentaloma in a 72-year-old male.
Why the study?
Paragangliomas and pheochromocytomas continue to be imaging mimics with atypical lesions presenting a diagnostic dilemma that necessitates a multimodal approach.
Case Report (n=1)
Atypical paragangliomas and pheochromocytomas can present as incidentalomas with imaging characteristics that deviate from classic patterns, requiring a multimodal diagnostic approach.
Atypical pheochromocytomas among incidentalomas warrant multimodal evaluation; case reports leave open standardized diagnostic criteria.
Incidental adrenal masses are frequently detected due to the extensive use of cross-sectional imaging, with about 3% to 7% of adults estimated to have them. Paragangliomas and pheochromocytomas (PPGL), rare tumors originating from paraganglia tissues, including the adrenal medulla, continue to be imaging mimics, necessitating a multimodal approach for accurate diagnosis. We report a case of 72-years male presenting with intermittent pain abdomen for the past 1 year. Preliminary imaging by ultrasound revealed a suspicious gall bladder polypoidal lesion along with choledochal cyst for which further characterization was done with both CT and MRI. On imaging besides defining the findings seen in USG, we encountered a large heterogeneously enhancing possible left adrenal incidentaloma. A homogeneously hyper enhancing lesion along the paraganglia distribution, with no evidence of washout and a high T2 signal, is a hallmark imaging characteristic of pheochromocytomas and paragangliomas. However, around 35% of atypical lesions, often altered by degenerative changes, deviate from these typical imaging patterns, presenting a diagnostic dilemma. Histopathological analysis, including immunohistochemistry, biochemical testing, and functional imaging, can offer valuable insights to help diagnose and aid in predicting prognosis.
No takes yet. Share an insight, caveat, or question.
Paudel et al. (2024) conducted a case report in Gall bladder adenocarcinoma and incidental left paraaortic mass (n=1). Diagnostic imaging (Ultrasound, CT, MRI) was evaluated. Multimodal imaging including ultrasound, CT, and MRI identified a suspicious gall bladder lesion and a large atypical left adrenal incidentaloma in a 72-year-old male.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: