Hemorrhagic adrenal metastases: CT findings

Adrenal hemorrhage secondary to metastases is uncommon. We have encountered four such cases that presented as large adrenal masses. In all cases the CT findings were of an inhomogeneous mixed-density adrenal mass with extensive perirenal changes suggestive of perirenal hemorrhage or mass. When such a lesion is seen, hemorrhagic adrenal metastases should be considered. Fluid may be of high density, suggestive of hemorrhage. However, as the adrenal is in the perinephric space, hemorrhage from any cause (trauma, metastases, or anticoagulant) in the adrenal gland will gravitate into the perinephric space.