74 year old male with an adrenal mass. ABDOMEN:LIVER, BILIARY TRACT: There is a 3.1 x 2.6 cm irregular mass in segment 2 of the liver with associated increased T2 signal abnormality and continuous/uninterrupted peripheral nodular enhancement on post contrast sequences suspicious for metastatic disease.SPLEEN: There is mass effect on the splenic vessels by the large necrotic mass adjacent to the right kidney.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The left adrenal gland is not definitively identified and may be engulfed or in continuity with the large heterogeneous, enhancing irregular mass, which is seen in alongside the superior pole of the left kidney, mass measures 10.0 x 8.3 cm (24; series 501). Given that the epicenter of the mass is suprarenal, an adrenal origin (as opposed to a large exophytic mass of renal origin) is favored. Alternatively, a dedifferentiated liposarcoma that engulfs the adrenal gland is another differential consideration. There is a right adrenal nodule that measures 3.1 x 2.8 cm, which demonstrates persistent enhancement on post contrast images and is suspicious for metastatic disease. KIDNEYS, URETERS: There is a large mass that appears to abut/exert mass effect on the left kidney. Given that the epicenter of the mass is suprarenal, an adrenal origin (as opposed to a large exophytic mass of renal origin) is favored. The left renal vein appears patent. Multiple subcentimeter foci of fluid signal intensity in the right kidney, too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: There is luminal narrowing of the intrahepatic IVC, vessel appears patent. Prominent lymph nodes also seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 3.6 x 2.8 cm mass in the right psoas muscle with associated heterogeneous enhancement (13; series 501). There is a 4.0 x 2.8 cm enhancing heterogeneous mass in the region of the left psoas muscle (9; series 501). Numerous additional subcentimeter enhancing foci are identified within the paraspinal musculature along the lower thoracic and upper lumbar spine. There is also an enhancing mass lesion along the lateral left hemiabdomen (4; series 1104). These findings are consistent with metastatic disease.Note is made of multiple foci of bone marrow signal abnormality in the pelvis and thoracolumbar spine, consistent with osseous metastatic disease.OTHER: There are numerous bilateral pulmonary nodules, consistent with metastatic disease, appearing increased in size when compared to the most recent CT examination when allowing for differences in technique. Trace bilateral pleural effusions.
1. Large enhancing 10.0 cm mass in the expected location of the left adrenal gland, which appears most consistent with a primary adrenal carcinoma, other differential considerations include metastatic disease or dedifferentiated liposarcoma with engulfment of adrenal gland, an exophytic renal malignancy is felt to be less likely given the suprarenal epicenter of the mass. 2. Right adrenal, hepatic, pulmonary, osseous and soft tissue metastatic disease, interval progression from the prior CT examination suggested, when allowing for differences in technique.