Relief of Double Incidentaloma: Clinical- Surgical Strategy Versus Instrumental Diagnostic Methods

Introduction: An incidentaloma is a tumor found by coinci- dence without symptoms or suspicion. Materials and Methods: We report a case of a male, 55 years–old patient subjected to abdominal CT scan for hematuria, with relief of right adrenal lesion. During our following labora- tory and instrumental study, there resulted only a right pulmonary densification (“ground-glass areas”). At preoperative chest X-ray, we found instead an opacity suspected for pulmonary neoplasy; so we carried out new chest CT, that confirmed it. However we per- formed a right VLS adrenalectomy for an histological definition and a next therapeutic strategy; meanwhile, the patient under- went to further chest CT (unchanged) and WB-PET (pulmonary superabsorber lesion with SUV>8). Histological examination of the adrenal lesion resulted positive for adenoma and, after mul- tidisciplinary consulting, suspecting a round atelectasis, we tried antibiotic and steroid therapy. Results: After therapy, the chest CT showed only apical fibrous streaks. Conclusions: Up to 7% of all patients over 60 may harbour a benign growth, often of the adrenal gland, which is detected when diagnostic imaging is used for the analysis of unrelated symptoms. The relief of an incidentaloma obliges a depth diagnostic instru- mental study, that however can’t replace clinical and surgical rea- soning.