Adrenal cavernous hemangioma: is presurgical diagnosis with imaging test possible

To describe a case of adrenal cavernous hemangioma in a 67 year old man who presented left lumbar pain. Abdominal ultrasound, contrast enhanced ultrasound of the lesion, abdominal-pelvic CT scan, and then left adrenalectomy and pathology were performed Imaging studies showed a large solid-cystic mass with 12 × 11 cm diameters in the left adrenal gland, well defined, with calcifications, which showed peripheral arterial globular contrast enhancement on CT and ultrasound. The lesion displaced neighboring structures without other findings in the abdominopelvic study. The pathology report after adrenalectomy was: cavernous hemangioma with calcifications, ossifications and necrosis. Cavernous hemangioma is a rare cause of adrenal mass. The globular peripheral contrast uptake and gradual filling of the lesion on dynamic imaging studies (Ultrasound or CT) and phlebolith type calcifications suggest the diagnosis of typical angioma. However, the presence of thrombosis, necrosis and calcifications in large lesions confer an unusual dynamic behavior and force pathology for definitive diagnosis.