Adrenal incidentaloma: nothing is ever as it seems

A 58-year-old female patient with cholelithiasis was referred for abdominal ultrasonography in January 2017. The ultrasonography revealed a large left adrenal tumor. The size of the lesion was 65 × 47 mm. High-resolution computed tomography was then performed. It showed a well-circumscribed left adrenal mass (RECIST: 64 mm) with fat stranding. The radiation attenuation coefficient was 27 Hounsfield units. After intravenous administration of contrast media, the tumor showed slight enhancement to 37 Hounsfield units, resulting from partition reinforcement.