S. Anna Hospital, Department of Diagnostic and Interventional Radiology, Ferrara, ItalyItaly
Department of Radiology and Medical Imaging, University of Ferrara, Ferrara, ItalyItaly
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A 56 year-old man with a history of gastroesophageal reflux disease was admitted to our Hospital with left abdominal pain. There was no history of vomiting, hematemesis, melena, tiredness or jaundice. Bowel sounds were normal and no masses were identified at clinical examination. An ultrasound abdominal scan was performed and a hypoechoic 24 mm mass in left adrenal loggia was reported. An abdominal CT scan showed a 2.4 cm rounded mass in the area of the left adrenal gland with densitometric mean values of -7 HU, interpreted as adrenal adenoma.
Gastric Diverticulum (GD) is an outpouching of the gastric wall. GDs are rare and they are commonly incidentally detected during diagnostic examinations of the abdomen. Prevalence ranges from 0.04% in upper gastrointestinal tract X-ray examination to 0.01%-0.11% at esophagogastroduodenoscopy.1
GDs are the least common diverticula of the gastrointestinal tract. Two main categories are identified, congenital and acquired. Diverticula of the gastric antrum, prepyloric or pyloric regions are extremely rare and usually asymptomatic. Clinical history may vary from complete absence of symptoms to dyspepsia, to major upper Gastrointestinal (GI) bleeding, making this condition a diagnostic challenge.2
Masses mimicking adrenal tumors appear more frequently on the left side due to the close proximity of the left adrenal gland to different structures such as the gastric fundus, the first loops of the jejunum, the spleen, the pancreas and the left kidney.3 Conditions such as gastric stasis, gastric diverticulum, duplicated bowel loop, accessory spleen, splenic vessels, aneurysm of the splenic artery, portosystemic venous collaterals (in portal hypertension), left renal and pancreatic tumors and submucosal gastric tumor may be difficult to differentiate from 4,5 left adrenal tumor.4,5
In order to prevent false diagnosis of adrenal tumor on CT, the adrenal region should be scanned with thin slices performed with multirow detector CT with the support of multiplanar reconstruction images. In the case of suspected gastric diverticula, oral administration of contrast medium may be indicated.
In conclusion, on the basis of our experience, the possibility of gastric diverticulum should be taken into consideration in the full differential diagnosis of adrenal masses.
We declare there are neither conflicts of interest nor acknowledgements’.
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