Daily Radiology Case

Explanation

The diagnosis is supported by the classic clinical triad of episodic severe hypertension, headache, palpitations, and diaphoresis, which strongly suggests catecholamine excess in a young patient. Contrast-enhanced CT shows a large, well-defined unilateral adrenal mass with heterogeneous enhancement and internal cystic or necrotic areas, findings typical of pheochromocytoma due to hemorrhage or degeneration within the tumor. The absence of macroscopic fat makes adenoma unlikely, and the lack of invasive features argues against adrenal cortical carcinoma. Metastasis is less likely given the patient’s age and absence of a known primary malignancy. Together, the clinical presentation and imaging findings strongly support pheochromocytoma, appropriately managed with pre-operative alpha-blockade followed by surgical resection.

Source: Niknejad M, Pheochromocytoma. Case study, Radiopaedia.org (Accessed on 20 Feb 2026) https://doi.org/10.53347/rID-186366

Hints

• A 30-year-old man presents with intermittent episodes of sudden severe hypertension that resolve spontaneously between attacks.
• During these episodes, he reports pounding headaches, palpitations, and profuse sweating that feel overwhelming and unpredictable.
• Blood pressure readings during the “spells” are markedly elevated, but normalize afterward, and he has no known history of chronic essential hypertension.
• Contrast-enhanced CT reveals a well-circumscribed, unilateral mass arising from the right adrenal gland measuring greater than 4 cm.
• The lesion demonstrates heterogeneous enhancement with internal cystic and necrotic components but no calcification, macroscopic fat, local invasion, or lymphadenopathy.
• Given the patient’s episodic catecholamine-type symptoms and imaging features of a large adrenal medullary mass, pre-operative alpha adrenergic blockade is initiated prior to surgical resection.