Incidental Lipid Poor Adrenal Mass in a Patient with Antiphospholipid Syndrome

Adrenal incidentalomas are commonly encountered in this era of ubiquitous imaging. The attenuation of the incidentaloma measured in Hounsfield units (HU) is an important step in the work up. Attenuation less than 10 HU indicates a benign lesion in more than 98% of cases, whereas attenuation greater than 30 HU is highly suspicious for adrenocortical cancer (ACC). Adrenal hematoma is rarely suspected clinically and exhibits no specific clinical symptoms or laboratory findings. There are multiple radiological features of adrenal hemorrhage and can mimic ACC. We present a case of an adrenal mass in a patient with antiphospholipid syndrome and discuss radiological clues to differentiate adrenal hematomas from ACC and thus avoid unnecessary surgical intervention.