Incidental finding of a large cystic mass in the left upper quadrant

Abstract

Solitary cystic masses are less common in the middle-aged than in the elderly patient group. A woman in her mid-30s presented with a history of mild hypertension that had been treated for the past 3 months. An abdominal sonogram was performed, which revealed a large cystic mass in the left upper quadrant between the spleen, pancreatic tail, and left kidney. The differentials included cortical cyst of left kidney, pancreatic pseudocyst, and splenic and adrenal cyst. A computed tomography scan was ordered to help determine the origin of this cyst, which narrowed the differential to adrenal cyst or pancreatic pseudocyst. Lab findings, such as serum amylase, serum lipase, and urinary catecholamines, were unremarkable. Fine-needle aspiration of the cyst under sonographic guidance did not reveal any malignancy or pancreatic enzymes; therefore, clinicians assumed it was adrenal in origin.