A 41-year-old man with weight loss, nausea, vomiting, and abdominal pain was referred for an abdominal CT scan to rule out intraabdominal pathology.

A dedicated CT of the abdomen was performed at our institution according to our standard venous phase protocol.

Following ingestion of positive oral contrast material (barium sulfate suspension 2.1% w/v, Mallinckrodt) and injection of 125 ml of iopromide, 300 mg I/mL (Ultravist, Bayer HealthCare), helical CT was obtained with a 65-s delays using a 64-slice GE Lightspeed VCT scanner (GE Medical Systems; Milwaukee, WI).

Axial sections of the abdomen showed a large (18×22×22 cm) heterogeneous retroperitoneal mass probably arising from the left adrenal gland containing multiple areas of macroscopic fat (Fig.1).

The patient had no documented clinical or laboratory evidence of adrenal hormonal excess.

On the basis of the clinical history and CT findings, the patient underwent surgical resection of the left adrenal mass, which was found on pathologic examination to represent a low-grade adrenocortical carcinoma.