Educational Point-of-Care Ultrasound Discovers Adrenal Cortical Carcinoma, a Case Report: Clinical Implications and Review of the Literature.

HCA healthcare journal of medicine Pub Date : 2025-08-01 eCollection Date: 2025-01-01 DOI:10.36518/2689-0216.1944
Minh Q Ngyuyen, Moshe Bengio, Vu H Tran
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Abstract

Introduction: Point-of-care ultrasound (POCUS) has become an indispensable tool for emergency physicians in assessing intra-abdominal pathology due to its real-time visualization, portability, and cost-effectiveness. While POCUS is not traditionally focused on adrenal gland assessment, incidental findings of adrenal masses during examinations have been reported. Our patient presented with a chronic obstructive pulmonary disease (COPD) exacerbation and was found to have a large adrenal mass, discovered incidentally, during thoracic ultrasound.

Case presentation: This case report presents the discovery of an adrenal mass in a patient with respiratory distress due to a COPD exacerbation, emphasizing the importance of sonographers' ability to identify abnormal imaging within their POCUS framework. The clinicians promptly communicated the incidental finding to the patient, leading to further imaging and labs while in the emergency department and subsequent hospital admission. Traumatic arteriovenous fistulas and visceral vascular injuries are rare.

Conclusion: Although adrenal glands are not the primary focus for emergent pathology, the identified mass prompted a comprehensive evaluation, ultimately revealing a nonhormone-secreting adrenal cortical carcinoma. The rarity of this malignancy and the discrepancy between imaging and laboratory results underscore the need for a thorough investigation, with the focus suggesting that POCUS, despite its limitations, can play a crucial role in prompting additional imaging for accurate diagnosis and informed patient management. This case also highlights the significance of transparent communication while empowering patients and guiding further investigations for a comprehensive understanding of the pathology.

教育护理点超声发现肾上腺皮质癌,1例报告:临床意义和文献回顾。
导读:即时超声(POCUS)由于其实时可视化、便携性和成本效益,已成为急诊医生评估腹腔内病理不可缺少的工具。虽然POCUS传统上不关注肾上腺评估,但在检查过程中偶然发现肾上腺肿块已被报道。我们的患者表现为慢性阻塞性肺疾病(COPD)恶化,并发现有一个大的肾上腺肿块,偶然发现,在胸部超声。病例报告:本病例报告在慢性阻塞性肺病(COPD)加重引起的呼吸窘迫患者中发现肾上腺肿块,强调超声医师在POCUS框架内识别异常成像能力的重要性。临床医生及时将这一意外发现告知患者,在急诊科和随后的住院期间进行了进一步的成像和实验室检查。外伤性动静脉瘘和内脏血管损伤是罕见的。结论:虽然肾上腺不是紧急病理的主要焦点,但已确定的肿块促使综合评估,最终揭示了非激素分泌肾上腺皮质癌。这种恶性肿瘤的罕见性以及影像学和实验室结果之间的差异强调了彻底调查的必要性,重点表明POCUS尽管有其局限性,但在促进准确诊断和知情患者管理的额外影像学方面可以发挥关键作用。这个病例也强调了透明沟通的重要性,同时赋予患者权力,并指导进一步的调查,以全面了解病理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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