The left adrenal mass is difficult to differentiate from a hemorrhagic gastric diverticula: a case report.

BACKGROUND

The complex periadrenal anatomy complicates differentiation between adrenal tumors and masses of extradrenal origin. Given the nonspecific clinical and radiological presentations, misdiagnosis occurs frequently. We report a case where a gastric diverticula (GD) was initially misdiagnosed as a left adrenal tumor on imaging. CASE PRESENTATION: A 50-year-old male presented with epigastric pain and discomfort. Gastroscopy showed gastric retention. Non-contrast CT suggested a left adrenal tumor, while abdominal MRI indicated a left adrenal neoplasm, with possible adenoma or pheochromocytoma. Adrenal hormone levels were normal. Surgical exploration revealed a morphologically normal left adrenal gland. Further dissection identified a mass arising from the gastric posterior wall, densely adhered to the adrenal gland and masquerading as a left adrenal tumor. Macroscopic examination confirmed a hemorrhagic GD — accounting for the contrast enhancement seen on imaging and explaining the diagnostic challenge in distinguishing it from an adrenal neoplasm.

CONCLUSIONS

To our knowledge, this constitutes the first reported case of a hemorrhagic GD mimicking a left adrenal mass.