IS Case 407: Right adrenal high grade malignant neoplasm with associated IVC thrombus

David Tuttle, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-27


Patient is a 67-year-old woman with history of 20 pounds of weight loss. A recent echocardiogram demonstrated a mass in the right atrium.


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Right adrenal high grade malignant neoplasm with associated IVC thrombus


Malignant adrenal lesions include adrenal metastases and adrenal carcinoma. Adrenal metastases are commonly found at autopsy in patients with malignant disease. The most common primary tumors are lung, breast, melanoma, GI, and renal. Small lesions are often difficult to distinguish from benign adenomas.

Adrenal carcinoma is an uncommon lethal tumor that is large and invasive at presentation. Half are hyperfunctioning and are accompanied with endocrine syndromes such as Cushing syndrome, virilization, and feminization. On CT they appear as a large mass with central necrosis, hemorrhage, and irregular enhancement. Delayed post contrast scans demonstrate poor washout similar to metastases, in contrast to benign adenomas which have much better washout. Approximately 1/3 have calcifications present. Associated findings may include tumor thrombus in the renal vein or IVC and hepatic and lymph node metastases. Adrenal tumors larger than 4-5 cm are typically removed because of the high risk of carcinoma.


  1. Brant W, Helms C. Fundamentals of Diagnostic Radiology, 3rd Ed. Philadelphia: Lippincott Williams & Wilkins, 2007.

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