Bilateral adrenal masses due to metastatic renal cell carcinoma

Unenhanced (A) and enhanced (B) axial CT images from a 54-year-old female who presented with shortness of breath. A chest CT scan had been performed to screen for pulmonary embolus and incidentally detected bilateral adrenal masses (arrows). In a subsequent abdominal CT scan, the right adrenal mass measured 11.7 × 8.6 × 9.1 cm with an unenhanced CT attenuation of 35 HU. The left adrenal mass measured 5.4 cm in maximum diameter and had an unenhanced CT attenuation of 39 HU. With contrast administration, both adrenal masses enhanced markedly and inhomogenously (B), and both had slow contrast washout (<50% at 10 minutes). The abdominal CT scan also detected a large right renal mass, which proved to be renal cell carcinoma. After excluding pheochromocytoma, biopsy of the right adrenal mass documented metastatic renal cell carcinoma.