A 69-year-old patient with a personal history of well-differentiated prostate adenocarcinoma treated with LHRH analogues and 2.5 cm right adrenal gland myelolipoma, incidentally diagnosed by CT performed 6 years ago.
She came to our emergency department with asthenia, anorexia, fever of 38.0o C, and abdominal pain of one week onset, with accidental fall of bed.
On physical examination, the patient was in a regular general state, although hemodynamically stable.
The abdomen was globulous and slightly distended.
Pain in the right hypochondrium with positive Murphy's sign was observed.
Cardiopulmonary auscultation was normal.
Complete blood count showed leukocytosis of 13,800 *10e9/L and neutrophilia (83%), hemoglobin of 110 g/l and bilirubin of 1.5 mg/dl after indirect bilirubin (0.9 mg/dl).
Emergency abdominal ultrasound showed a large heterogeneous mass of 16 cm in diameter depending on the right adrenal gland with compression of the vena cava, without being able to discern if it was a hematoma or abscess.
The CT confirmed this finding, reporting a hematoma with signs of active bleeding, 16 cm in diameter, compressing and displacing the vena cava.
Urgent laparotomy was indicated in which right adrenalectomy and excision of the hematoma were performed.
The postoperative period was uneventful and the patient was discharged on the tenth day.
