The patient presented with hirsutism, central obesity, and striae rubrae. Blood pressure was at 180/110 mmHg. Blood cortisol levels were elevated and ACTH suppressed. There was a palpable mass in the right upper and middle abdomen.
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Coronal HASTE showing a centrally necrotic tumor displacing the right kidney and its hilum caudally.
Transverse T1 image with fatsat after iv Gd. The mass shows an inhomogeneous enhancement pattern with avascular necrosis..
MRI showed a massive tumor between the liver and right kidney. The kidney was displaced caudally (Fig. 1). After contrast, the tumor showed heterogeneous enhancement with a large central necrosis (Fig. 2).
The large size of the adrenal mass and the central necrosis is compatible with adrenal cortical carcinoma.