Incidentally Detected Cystic Pheochromocytoma on Computed Tomography in a Patient Presenting With a Urinary Tract Infection: A Report of a Rare Case

Pheochromocytomas are rare catecholamine-secreting neuroendocrine tumors originating from the adrenal medulla, presenting with classic symptoms of headache, diaphoresis, and palpitations due to paroxysmal hypertension. Generally, pheochromocytomas are solid or sometimes solid with cystic changes. Purely cystic pheochromocytoma is very uncommon, with only a limited number of cases reported. We present the case of a 42-year-old male with cystic pheochromocytoma who presented with symptoms of urinary tract infection and, on imaging, was found to have a left adrenal purely cystic lesion. On imaging, a cystic lesion with an enhancing wall, showing no solid component, calcification, hemorrhage, or necrosis, was noted in the left suprarenal region. On this, the possibility of pheochromocytoma was kept. However, his biochemical markers were normal. The patient underwent an adrenalectomy with excision of the lesion, and histopathology and immunohistochemistry confirmed it as a cystic pheochromocytoma. A purely cystic pheochromocytoma needs consideration as one of the diagnoses in cystic adrenal lesions, particularly in a patient with unusual clinical features, and imaging is suggestive of a purely cystic adrenal lesion.