49-year-old male with labile blood pressure and flushing as well as history of adrenal mass, evaluate for pheochromocytoma. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: In the region of the right adrenal gland, there is a well circumscribed mass measuring 4.5 x 5.4 cm in the axial plane x 4.6 cm in the craniocaudal dimension. The lesion is predominantly solid with several central cystic components. The solid components demonstrate moderately increased T2 signal and intermediate T1 signal. The solid components demonstrate avid enhancement on postcontrast images with some apparent washout on more delayed images. The lesion does not appear to contain macroscopic or microscopic fat. Mild to moderate mass effect on adjacent IVC noted.Left adrenal gland appears within normal limits.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is rightward curvature of the thoracic spine and leftward curvature of the lumbar spine.OTHER: No significant abnormality noted.
Right adrenal tumor measuring 4.5 x 4.6 x 5.4 as described above. Given imaging features and clinical scenario including a history of hypertension and a lack of a primary malignancy, favor a pheochromocytoma. Other differential considerations such as metastatic disease or an adrenocortical carcinoma considered much less likely. 