Presentation
Patient with excessive secretion since birth. Previous ultrasound scan showed well defined left upper quadrant cystic lesion.
Patient Data
Normally oriented bilateral adrenal glands that maintain their cortical-medullary differentiation. The right adrenal gland (with a typical y-shaped appearance) spans an area of 0.53 cm² while its contralateral left counterpart (with a more spoon-fork appearance) spans an area of 1.22 cm².
The rest of the abdominal viscera are uneventful however, a turgidly distended gastric lumen with anechoic fluid content and intrinsically suspended focal soft solid material of homogeneous hypoechogenicity that is gently peripherally lobulated (most likely a gastric bezoar) is noted. The gastric material aforementioned is avascular on color Doppler imaging and is almost non-adherent to the gastric inner mucosa. The pyloric sphincter and canal are mildly tapered albeit open and no pyloric muscular wall thickening is evident.
Case Discussion
The adrenal glands are orthotopic at the extrinsic upper renal polar regions bilaterally and as appreciated here, are rarely symmetrical. Their shapes may or may not resemble bilaterally either but are largely normally confined into; pyramidal, crescentic, lambda, y, comma, or wishbone-shaped appearances when normal with both having a body and a limb(s).
In this case, the right adrenal gland body spans a length of 1.83 cm with an overall width of 0.26 cm while its left counterpart spans a body length of 1.89 cm with an overall width of 0.33 cm. Their respective lateral and the medial wings are present as well and are separated anteromedially with a ridge for the right and two ridges for the left gland.
The turgidly distended neonatal gastric lumen (with lactobezoar content visualized freely floating within the clear milk content) was clinically managed.
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