SPONTANEOUS RETROPERITONEAL HEMATOMA AS A RARE COMPLICATION OF AN ADRENAL METASTASIS

History and clinical findings: A 58-year-old man was hospitalized beca use of acute dull upper abdominal pain, radiating into the right flank and lower abdomen. The past history was unremarkable expect for thyro idectomy, performed 30 years previously for thyroid carcinoma. There w as painful resistance on palpation of the right upper abdomen. The pat ient had not recently sustained any trauma. Biochemical and imaging in vestigations: Erythrocyte sedimentation rate was increased to 38mm/h, haemoglobin concentration was 11.7 g/dl but fell to 9.9 g/dl within th e first 24 hours. Ultrasound and computed tomography (CT) revealed a l arge retroperitoneal mass (5 x 6.5 x 15 cm), its density of 64 Hounsfi eld units most strongly suggesting an haematoma. CT also showed enlarg ement of the right adrenal. Chest radiography demonstrated a space-occ upying lesion in the right upper lobe. Diagnosis, treatment and course : As a retroperitoneal heamatoma of uncertain aetiology was suspected, a laparotomy was performed. The haematoma was evacuated and the adren al, showing tumours changes, was excised. Histologically it was a muco cellular metastasis. The chest radiograph suggested carcinoma of the l ung as the primary. The illness took a rapidly fatal course. Autopsy c onfirmed a poorly differentiated adenocarcinoma of the lung. Conclusio n: Trauma or anticoagulation should be considered first in the differe ntial diagnosis of retroperitoneal haematoma of uncertain aetiology. H owever, adrenal metastasis should be thought of as a rare possibility.