Objective: We report a patient with a large adrenal pseudocyst presenting with epigastric distress and abdominal distention. Clinical Presentation and Intervention: A 35-year-old man presented with a 1-year history of nonspecific epigastric distress and abdominal distention. Routine laboratory tests and endocrine function tests were within the normal ranges. Magnetic resonance imaging (MRI) revealed a large left adrenal cyst. Adrenal cyst showed low intensity on T-1-weighted MRI images and high density on T-2-weighted MRI images. The patient underwent surgery, and the cyst was completely removed. Histological examination showed that the cyst wall consisted of hyalinized fibrous tissue without an epithelial or endothelial lining, and a diagnosis of an adrenal pseudocyst was made. Symptoms resolved after pseudocyst removal. Conclusion: The report showed a patient with adrenal pseudocyst, a rare and uncommon condition that was diagnosed on MRI images and confirmed by histology. The epigastric distress and the abdominal distention resolved after the pseudocyst was surgically removed. Copyright (C) 2005 S. Karger AG, Basel.