PMC9749039_01
(A) Imaging findings results of the CT scan and 123I-MIBG scintigraphy. CT scan revealed an internal low density mass in the right adrenal gland, and 123I-MIBG scintigraphy confirmed uptake in the same mass. (B) Change in abdominal radiograph. Abdominal radiographs on admission (a), after phentolamine administration (b), and after surgery (c). Marked intestinal distension and gas were partially relieved by phentolamine administration and were completely improved by adrenalectomy.. CT, computed tomography; MIBG, 123I-metaiodobenzylguanidine.
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The thyroid function test showed low levels of free triiodothyronine and free thyroxine without elevated levels of thyroid-stimulating hormone, suggesting a nonthyroidal illness (Tables 1 and 2). 123I-metaiodobenzylguanidine (MIBG) scintigraphy showed uptake in the right adrenal mass (Figure 1(A)). Constipation and intestinal gas retention completely improved after surgery (Figure 1(B)).A year after surgery, the patient gained back 7 kg, and his BMI improved to 12.3 kg/m2.
Clinical course. The top section shows the changes in the CT scan, and the bottom section shows the change in the white blood count and C-reactive protein. Antibiotic treatment and ultrasound-guided drainage improved the inflammatory response. The low density region of the liver indicating abscess disappeared on the 38th day. The picture shows a sample taken from drainage (A). Yellowish pus was aspirated with positive culture results for Escherichia coli and Bacteroides. The black arrows indicate the pheochromocytoma, and the dotted line indicates the liver abscess.. CRP, C-reactive protein; CT, computed tomography; WBC, white blood count.
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Percutaneous drainage and antibiotic therapy improved the inflammatory response and fever (Figure 2).
123I-MIBG scintigraphy showing the adrenal mass and liver abscess. The top row shows the CT scan (a) and 123I-MIBG scintigraphy (b) images. The bottom row provides a description of the image. The circle indicates the adrenal mass, and the white arrows indicate the liver abscess. Area of the liver abscess showed no uptake on 123I-MIBG scintigraphy.. CT, computed tomography; MIBG, 123I-metaiodobenzylguanidine.
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No uptake was observed in the low density areas of the liver (Figure 3).The presence of adrenal nodules with uptake on 123I-MIBG scintigraphy and high catecholamine levels led to a definite diagnosis of an adrenal pheochromocytoma.