Retroperitoneal varices presenting as an adrenal pseudotumor in a cirrhotic patient.

Herein is reported a case of a putative tumor of the left adrenal gland found incidentally during the workup of a cirrhotic patient with portal hypertension. This mass manifested vascular enhancement and other features of an adenoma both on computed tomography (CT) and magnetic resonance imaging (MRI) scans. Additional workup revealed elevated salivary cortisol and plasma aldosterone levels. A proposed biopsy of this mass was deferred because of an episode of variceal bleeding that required placement of a transjugular intrahepatic portosystemic shunt (TIPS). Post TIPS placement, repeat CT and MRI scans showed that the mass had disappeared, indicating that this pseudotumor was, in fact, a knot of peri-adrenal varices, which was now decompressed. In this report, the anatomic and pathologic basis of peri-adrenal varices in a patient with portal hypertension is discussed, as well as the ability of current imaging studies at establishing this diagnosis. Liver disease may cause abnormalities in endocrine function, which make this diagnosis difficult.

Amelioration of hypertrophic cardiomyopathy using nonsurgical septal ablation in a cirrhotic patient prior to liver transplantation.

A 53-year-old male with hepatitis C cirrhosis, who had been refused liver transplantation because of hypertrophic cardiomyopathy (HC), underwent nonsurgical septal ablation using alcohol with resolution of his ventricular outflow obstruction. This patient was able to subsequently undergo a successful deceased donor liver transplantation. This is the first reported case of alcohol induced septal ablation being performed in a cirrhotic patient with HC. Such nonsurgical procedures may be attractive in cirrhotic patients who are refused access to liver transplantation because of high surgical risk.