Misdiagnosed gastric diverticulum as a left adrenal lesion on imaging

Abstract

Key clinical message: Gastric diverticulum in the posterior wall of the stomach is very rare, and it is easy to be misdiagnosed as a left adrenal mass on imaging. Therefore, we must consider the possibility of gastric diverticulum when diagnosing a left adrenal mass.

Abstract: This paper reports a case of gastric diverticulum that was misdiagnosed as a left adrenal mass on abdominal enhanced CT. The patient underwent laparoscopic adrenalectomy, but there was no mass in the left adrenal found during surgery. After the incision of the retroperitoneum, a cystic mass was found adjacent to the posterior gastric wall which turned out to be gastric diverticulum. This case suggests that gastric diverticulum, a rare disease, may be interpreted as an adrenal mass on imaging. Therefore, as a urologist, the gastric diverticulum must be excluded when CT suggests a mass in the left adrenal region.

Keywords: CT imaging; gastric diverticulum; left adrenal lesion; misdiagnosis; treatment.

FIGURE 1

Preoperative adrenal enhanced CT (A) medium high‐density adrenal mass; (B) the solid arrow points to a bubble in the adrenal occupation, and the dashed arrow indicates that the occupation appears to be continuous with the posterior gastric wall; (C) mixed‐density shadow in the left adrenal region; (D) space occupation is closely related to the adrenal glands.

FIGURE 2

Preoperative repeat CT scan (A) medium high‐density adrenal mass that became larger than Fig. 1A; (B) the solid arrow represents a bubble in the adrenal occupation and the dashed arrow indicates that the occupying position seems to be continuous with the posterior gastric wall; (C, D) mixed‐density shadow in the left adrenal region that the shape and location of which had changed.

FIGURE 3

Intraoperative imaging. The solid arrow represents the gastric wall, and the dashed arrow represents the gastric diverticulum.

FIGURE 4

Postoperative examination. (A) Adrenal CT scan 3 days after operation: the solid arrow points to the bubble, and the dashed arrow points to a flattened cystic lesion; (B) gastroscopy performed after operation: the arrow points to the gastric diverticulum.