84-year-old female with right renal mass. Evaluate right renal versus adrenal mass. Evaluate IVC involvement. ABDOMEN:LIVER, BILIARY TRACT: There are at least 3 lesions of the right hepatic lobe demonstrating increased T2 signal hyperintensity, contiguous peripheral enhancement, and restricted diffusion, appearance most concerning for metastatic disease (series 5 images 7, 15) (series 10 images 356, 342) (series 100103 images 465, 479). Portal vein displaced by large right suprarenal mass lesion, described below.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Large heterogenous mass most likely originating from the right adrenal gland (a normal right adrenal gland is not seen) based on imaging measuring 18.4 x 13.7 x 15.8 cm (axial series 5 image 33, coronal image 25). The large mass exerts mass effect on the right kidney (displaced inferiorly) and left hepatic lobe superiorly. Heterogenous enhancement is noted on the postcontrast series. There is encasement of the infrahepatic IVC, which also contains intraluminal thrombus (series 10 image 440). No significant abnormality of the left adrenal gland.KIDNEYS, URETERS: In the right lower renal pole, there is a 2.1 x 2 cm T1 hyperintense focus compatible with a proteinaceous cyst (series 10 image 15). Additional subcentimeter T2 hyperintense foci, favored to be tiny cysts. In the left mid kidney, there is a minimally complex cyst containing T2 hyperintense signal with layering T1 hyperintense debris inferiorly (series 4 image 66, series 6 image 12). In the left kidney, there are multiple subcentimeter T2 hyperintense foci, small size makes definitive characterization difficult but favor cysts.On the postcontrast subtraction series, no suspicious enhancing components identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Large heterogenous enhancing mass likely originating from the right adrenal gland measuring 18.4 x 13.7 x 15.8 cm. Associated IVC encasement and invasion seen tumor thrombus seen. Malignancy specifically adrenocortical carcinoma is favored in light of suspicious hepatic lesions concerning for metastatic disease. 2.Bilateral renal cysts, some containing T1 hyperintense/proteinaceous material. There is a minimally complex cyst of the left lower renal pole containing layering T1 hyperintense debris. No suspicious enhancing components delineated. 