A Huge Adrenal Pseudocyst Mimicking A Hepatic Cyst: A Case Report

Introduction: Adrenal cystic lesions are rare and often benign. They can present a significant diagnostic challenge, as their non-specific symptoms and retroperitoneal location often lead to misidentification as a hepatic or renal cyst on imaging. Case Presentation: A 24-year-old woman presented with a 5-year history of recurrent right upper abdominal pain. Preoperative imaging, including ultrasonography and contrast-enhanced CT, identified a large (10.3cm x 12cm x 15 cm) cystic lesion initially diagnosed as a hepatic cyst. During laparotomy, the cyst was found to be retroperitoneal, displacing the liver and right kidney. It was completely excised after intraoperative rupture. Histopathological examination of the specimen revealed a cyst wall devoid of epithelial or endothelial lining, consistent with a definitive diagnosis of a benign adrenal pseudocyst. Conclusion: This case highlights the diagnostic difficulty posed by large adrenal pseudocysts, which can mimic more common hepatic cysts. It underscores that preoperative imaging may be inconclusive, and histopathological evaluation remains the gold standard for definitive diagnosis. Complete surgical excision is both therapeutic and diagnostic for such large, symptomatic lesions.