Question 1104
{"accessible":false,"alternatives":[{"id":5516,"text":"a 5 cm indeterminate mass should be followed up with imaging in 6 months"},{"id":5512,"text":"a mean density of 40 HU on portal venous phase CT is highly suggestive of a lipid rich adenoma"},{"id":5513,"text":"an absolute washout on adrenal CT of 70% is diagnostic for an adenoma"},{"id":5514,"text":"an isolated adrenal metastasis requires exclusion with a washout CT"},{"id":5515,"text":"size stability over 6-12 months is consistent with a benign lesion"}],"archived":false,"correctAlternativeId":5515,"explanation":"\u003cp\u003eA 5 cm adrenal mass is suspicious for malignancy\u0026nbsp;and is automatically considered a surgical lesion.\u0026nbsp;\u003c/p\u003e\u003cp\u003eA diagnosis of a lipid-rich adenoma cannot normally be made on a PV phase CT.\u003c/p\u003e\u003cp\u003eWashout CT has no routine role in the workup of an incidental adrenal mass for several reasons. Firstly,\u0026nbsp;30% of pheochromocytomas (third most common adrenal tumor) have enhancement behaviors that overlap with adenomas. Secondly,\u0026nbsp;the washout CT is designed and validated for oncology patients who have a pre-test probability of up to\u0026nbsp;50% for\u0026nbsp;a metastasis,\u0026nbsp;and if the washout is negative for an adenoma in this setting\u0026nbsp;the adrenal mass can be regarded as a metastasis, however the same does not apply to incidental lesions in non-oncology patients.\u003c/p\u003e\u003cp\u003eA previously unknown malignancy presenting as an isolated metastasis is exceedingly rare (\u0026lt;0.01% of all incidental tumors) and therefore washout CT is not recommended to exclude metastasis in this setting.\u0026nbsp;\u003c/p\u003e\u003cp\u003eSize stability over 6-12 months is consistent with a benign lesion and is the correct answer option.\u0026nbsp;\u003c/p\u003e","id":1104,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/1689","nextQuestionPath":"/articles/adrenal-adenoma/questions/124","relatedArticles":[{"id":25045,"title":"Adrenal metastasis","link":"/articles/adrenal-metastasis-1?lang=us"},{"id":34779,"title":"Adrenal washout","link":"/articles/adrenal-washout?lang=us"},{"id":7972,"title":"Adrenal lesions (differential)","link":"/articles/adrenal-lesions-differential?lang=us"},{"id":8642,"title":"Pheochromocytoma","link":"/articles/phaeochromocytoma-1?lang=us"}],"alsoUsedIn":[{"id":233,"kind":"RestrictedPage","title":"Page 233 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/233"},{"id":239,"kind":"Course","title":"Radiology Review Course - Melbourne - page 239","link":"https://radiopaedia.org/courses/radiology-review-course-melbourne-2019/pages/239"},{"id":239,"kind":"Course","title":"Radiology Review Course - Melbourne - page 239","link":"https://radiopaedia.org/courses/radiology-review-course-melbourne-2018/pages/239"},{"id":239,"kind":"Course","title":"Radiology Review Course - Melbourne - page 239","link":"https://radiopaedia.org/courses/radiology-review-course-melbourne-2020/pages/239"},{"id":239,"kind":"Course","title":"Radiology Review Course - page 239","link":"https://radiopaedia.org/courses/radiology-review-course-online/pages/239"},{"id":634,"kind":"Course","title":"Radiopaedia 2020 - Lectures Only - page 634","link":"https://radiopaedia.org/courses/radiopaedia-2020-exclusive/pages/634"},{"id":634,"kind":"Course","title":"2020 Virtual Conference Private Use - page 634","link":"https://radiopaedia.org/courses/2020-virtual-conference-private-use/pages/634"}],"stem":"\u003cp\u003eWhich of the following statements is most correct with regards to an incidental adrenal mass?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1104"}],"attemptsPercentages":[{"alternativeId":"5514","percentage":7},{"alternativeId":"5515","percentage":59},{"alternativeId":"5513","percentage":24},{"alternativeId":"5516","percentage":8},{"alternativeId":"5512","percentage":2}],"promptToLogin":false,"questionManager":false,"articleId":"adrenal-adenoma"}