A carcinoma can be suspected as the cause of an adrenal mass based on its imaging features.


Common sites for primary tumors:

(1) lung

(2) breast



(1) variable, may be small or large

(2) The change in size may be variable depending on the type of tumor

(3) often bilateral


Shape: variable, with unclear margins


Imaging features of an adrenal carcinoma:

(1) heterogeneous texture with areas showing mixed densities

(2) attenuation (density) on unenhanced CT is usually > 25 Hounsfield units (almost all have a density > 10 HU)

(3) vascular

(4) washout of contrast material is < 50% at 10 minutes

(5) T2-weighted MRI images are hyperintense in relation to the liver

(6) necrosis and hemorrhage may be present

(7) calcifications may be present


It may be difficult to distinguish metastatic carcinoma from a hormonally silent adenoma or pheochromocytoma, especially if there is no diagnosis of extra-adrenal cancer.


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