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

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.