US – Right kidney presented slight pyelectasia. Ill-defined pelvic fat also noted suggestive for pyelonephritis. Right kidney measured 5.15 cm. Left kidney measured 4.33 cm in oblique position. Left kidney also presented pyelectasia suggestive for pyelonephritis. Left adrenal measured 0.5 cm, uniform contour. Right adrenal mass was noted with pericapsular inflammatory pattern. The mass measured approximately 4 cm with regional inflammation; appears potentially resectable. No overt evidence of invasion of the vena cava noted. Focal areas of mineralization or necrosis was noted.

Follow-up CT of the abdomen – A rightsided expansile and slightly ill defined adrenal mass of 4 x 3.5 x 3 cm is seen.
The mass reveals extensive invasion into the caudal vena cava obstructing 90 % of the
vascular diameter. Only marginal blood flow is maintained. Collateral perfusion
bypassing the vascular obstruction has developed. The mass itself reveals a
heterogenous attenuation pattern with multifocal mineralization and non-uniform
contrast enhancement. Mild localized retroperitoneal effusion and fat stranding is noted
surrounding the mass. Hypo-attenuating and hypo-enhancing nodules of up to 1 cm diameter are seen within
the left medial and lateral liver lobes. Multifocal iso-attenuating but hypo-enhancing wedge shaped cortical lesions are seen
within the left kidney.