EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma

Background: EUS presents an alternative access to the left adrenal, making it possible to perform echo-guided needle biopsies. Objectives: We present a case of EUS-guided therapy as alcohol ablation of left adrenal metastases. Design and Patient: A 52-year-old man was admitted to the hospital complaining of abdominal pain. CT scan revealed an invasive process in the left upper lobe of the lung and a mass in the left adrenal area that was considered highly suspicious for left adrenal metastases from the patient's lung carcinoma. Cytopathologic examination of EUS-guided FNA confirmed the diagnosis of left adrenal metastasis. Because the patient's main clinical symptom was disabling abdominal pain, we considered the possibility of injection of alcohol into the left adrenal metastases under EUS guidance to ablate the metastatic lesion and potentially relieve the abdominal pain. EUS-guided alcohol ablation was performed successfully. Results and Main Outcome Measurement: On follow-up 3 days after EUS-guided left adrenal ablation, the patient had no abdominal pain. He remained without abdominal pain after 30 and 60 days of follow-up. Limitation: New technique with limited data. Conclusion: EUS-guided alcohol ablation of left adrenal metastases in patients with non-small-cell lung cancer may provide palliation of cancer-related abdominal pain. There may be potential for combining this (minimally invasive and easily performed EUS-guided therapeutic) technique for ablation of solitary adrenal metastasis in patients with lung cancer with other modalities (e.g., surgery, radiation, or chemotherapy) directed toward the primary pulmonary malignancy and adjacent mediastinal disease.