PMC6011133_01
Adrenal-protocol CT abdomen, coronal demonstrates a 5 x 6.7 x 7 cm right adrenal mass (white arrows) with areas of calcification. Hounsfield units (HU): nonenhanced 36 HU (>10 HU indeterminate for adenoma), enhanced 84 HU, and delayed 73 HU. Absolute washout 22.9% (<60% indeterminate for adenoma).
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Before initiation of Harvoni, he underwent CT imaging of the abdomen with contrast which found a 5 x 6.7 x 7 cm right adrenal mass (Figure 1). The absolute contrast washout of 22.9% was indeterminate for adrenal adenoma (Figure 1).
Resected specimen at the time of surgery. Histologic examination of the specimen revealed that the large dominant nodule was a benign cavernous adrenal hemangioma with hemorrhage (Figure 3).
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The resected specimen weighed 126 grams and measured 7.5 x 6.5 x 4.7 cm on gross pathology (Figure 2).
Histological examination with hematoxylin and eosin staining revealed multiple blood-filled spaces lined by an individual layer of vascular endothelium, typical of a cavernous hemangioma.
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Within the specimen was a 6.4 x 5.5 x 4.7 cm intraparenchymal nodule, which on histologic examination proved to be a cavernous hemagioma (Figure 3).