Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge

Incidental left paraaortic mass in a patient with gall bladder adenocarcinoma: A diagnostic challenge

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Incidental adrenal masses are frequently detected due to the extensive monarch caterpillar plush 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 keychron m6 mouse 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.