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AJR teaching file: Incidental adrenal mass and hypertension.

Radiologic Description Unenhanced abdominal CT (Fig. 1A) illustrates a well-defined, 3.9-cm left adrenal mass with mixed isoand hypodensity. No calcifications are associated with the lesion, and no adenopathy is seen. The contralateral adrenal gland is normal. The average attenuation of the lesion is 27 H, prompting further evaluation with contrast material. Arterial phase CT (Fig. 1B) shows heterogeneous enhancement with a mean attenuation of 44 H. Axial CT images delayed 15 minutes after administration of contrast material (Fig. 1C) exhibit no substantial washout (< 50%), and the average attenuation is 40 H. Attenuation greater than 10 H on unenhanced CT and the lack of washout on delayed images suggests a malignant rather than a benign process. A reconstructed tomographic image from PET (Fig. 1D) illustrates increased glucose metabolism from a left adrenal mass; standard uptake value is 10.5. Normal glucose metabolism is evident in the kidneys, bladder, and heart. Subsequent iodine-131 metaiodobenzylguanidine (MIGB) scintigraphy (not shown) shows minimal uptake. Avid activity is seen in a reconstructed tomographic image from a indium-111 octreotide scan (Fig. 1E). The liver, spleen, and kidneys exhibit normal physiologic activity.