PMC3268705_01
(A) Ultrasound aspect of dilated common bile duct with images suggestive of choledocholithiasis (arrows). (B) Computed tomography saggital view showing the mass in the right adrenal topography (arrow).
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F1
During transabdominal ultrasound (US), intrahepatic and extrahepatic bile duct dilatation and stones in the common bile duct were observed (Figure 1A). A large, well-defined, soft tissue density lesion with intrinsic fat density areas in the right adrenal topography was identified (Figure 1B).
Protrusion of the left hepatic lobe (arrow heads) through the abdominal wall defect (arrow) on axial view of computed tomography.
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F2
A computed tomography (CT) scan revealed a midline abdominal wall hernia defect with protrusion of the left hepatic lobe (Figure 2).
Surgical aspect once the left hepatic lobe was dissected and the hernia content was reduced.
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F3
A left lobe protrusion through the abdominal wall defect was found, and a reduction of the lobe to its normal position was performed (Figure 3).
(A) Macroscopic aspect of the right adrenal mass. (B) Histology demonstrated a solid tumor formed by well-differentiated adipose cells, fibrous stroma in regular septa, and lymphoid cells, indicative of an adrenal myelolipoma (hematoxylin and eosin, x10).
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F4
Macroscopically, a 12cm, yellowish, soft tumor was found (Figure 4A). Histopathology revealed a solid tumor formed by completely differentiated adult-type adipose cells, fibrous stroma in regular septa with scarce venous capillaries, and scattered or grouped lymphoid cells, indicative of an adrenal myelolipoma (Figure 4B).