Gastric Diverticulum Misdiagnosed as a Left Adrenal Lesion

Abstract

We report a case of gastric diverticulum misdiagnosed as a left adrenal lesion on both
ultrasound and CT imaging and later identified on a follow-up CT.
A 56 year-old man with a history of gastroesophageal reflux disease was admitted to
our Hospital with left abdominal pain. There was no history of vomiting, hematemesis, melena,
tiredness or jaundice. Bowel sounds were normal and no masses were identified at clinical
examination. An ultrasound abdominal scan was performed and a hypoechoic 24 mm mass in
left adrenal loggia was reported. An abdominal CT scan showed a 2.4 cm rounded mass in the
area of the left adrenal gland with densitometric mean values of -7 HU, interpreted as adrenal
adenoma (Figure 1). In the following days the patient underwent a complete endocrinological
evaluation that showed normal findings with normal adrenal function; ACTH level and urinary
catecholamines were both within normal range. The patient was then discharged and scheduled
for a follow-up CT.
After 6 months the patient underwent a second follow-up CT that showed a little intralesional
gas bubble (Figure 2); CT scan was subsequently repeated after oral administration
of contrast medium (Gastrografin®); the previously described lesion showed continuity with the
gastric wall, contrast medium staining of the lumen lesion with contextual air bubbles suggestive
of gastric diverticulum (Figure 3 and 4). Diagnosis was later confirmed by esophagogastroduodenoscopy.