Differentials for bilateral adrenal masses:
Adrenal hyperplasia, metastases, haemorrhage, phaeochromocytoma/synchronous primary adrenal tumour, lymphoma.
Large bilateral soft-tissue density adrenal lesions. No internal fat or calcification.
LEFT ADRENAL LESION
Pre-contrast: 33 HU
Portal venous contrast: 59 HU
15 minute delayed: 58 HU
Absolute washout: 3.8%
Relative washout: 1.7%
RIGHT ADRENAL LESION
Pre-contrast: 28 HU
Portal venous contrast: 33 HU
15 minute delayed: 30 HU
Absolute washout: 60%
Relative washout: 9.1%
The washout characteristics for the left adrenal lesion are indeterminate. The right adrenal lesion is not enhancing, which is more characteristic of a cyst or hematoma.
Size 4cm is concerning for malignancy, including metastases or bilateral adrenal cortical carcinomas, although the lack of enhancement on the right does not suggest carcinoma.