Mass in the Adrenal Region: Not Always of Adrenal Origin: A Diagnostic Dilemma

The rising incidence of incidentally detected adrenal masses reflects the ever growing use of radiologic investigations specially CT scans and MRI. The differential diagnosis is a long list which includes adenoma, myelolipoma, cyst, lipoma, pheochromocytoma, adrenal cancer, metastatic cancer, hyperplasia, and tuberculosis.[5] However rarely a schwannoma is considered in the list of provisional diagnosis. CT scan is often the first line of investigation of choice which along with endocrinological workup can point towards diagnosis. But none of them are 100% specific. Since the posterior mediastinum is anatomically in proximity to the adrenal area, a tumour in such a region can mimic an adrenal mass as was in our case. We herein report such an unusual case where a posterior mediastinal mass was found intraoperatively instead of a ‘presumed’ adrenal mass as suggested by preoperative radiological investigations!