Differential Diagnosis for Adrenal Congestion and Epigastric Pain
Single Most Likely Diagnosis
- Acute Pancreatitis: The patient's presentation with epigastric pain and elevated WBC count, along with the finding of adrenal congestion on CT, suggests a possible inflammatory process in the vicinity of the pancreas. Acute pancreatitis can cause adrenal congestion due to its proximity and potential for inflammation to spread.
Other Likely Diagnoses
- Pyelonephritis or Perinephric Abscess: Given the adrenal congestion and elevated WBC, an infectious process such as pyelonephritis or a perinephric abscess could be considered, especially if there are symptoms or signs suggestive of a urinary tract infection.
- Retroperitoneal Lymphadenitis: Inflammation of the lymph nodes in the retroperitoneum could cause congestion in the adrenal area and could be related to various infectious or inflammatory conditions.
- Retroperitoneal Hemorrhage: Although less likely without a history of trauma, a spontaneous retroperitoneal hemorrhage could cause adrenal congestion and epigastric pain, especially if it involves or presses on nearby structures.
Do Not Miss Diagnoses
- Pheochromocytoma with Hemorrhage: Although rare, a pheochromocytoma (a type of adrenal gland tumor) with hemorrhage could present with acute pain and could potentially cause adrenal congestion. This diagnosis is critical to consider due to its potential for severe hypertension and other life-threatening complications.
- Adrenal Hemorrhage: Spontaneous adrenal hemorrhage can present with acute abdominal or back pain and could be life-threatening, especially if bilateral.
- Retroperitoneal Sarcoma: A rare tumor in the retroperitoneum could cause local compression and congestion, including of the adrenal glands, and is important to consider due to its potential for malignancy.
Rare Diagnoses
- Adrenal Vein Thrombosis: This condition could potentially cause adrenal congestion and is more likely in patients with hypercoagulable states or severe dehydration.
- Histoplasmosis or Other Fungal Infections: In endemic areas, histoplasmosis or other fungal infections could cause adrenal congestion as part of a disseminated infection.
- Tuberculosis: Although rare in many parts of the world, tuberculosis can affect the adrenal glands and cause congestion, especially in immunocompromised patients or those from endemic areas.