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Will you give me your opinion on my CT results?

I had a CT scan that revealed an adrenal mass. I then had a follow up CT with adrenal protocol.

The original CT revealed the following:
There are multiple wedge-shaped subcapsular hypodense findings within the liver, seen within segment 4 a at the hepatic dome, and within segment 6. The largest of these measures 3.3 cm.

There is a 4.6 cm circumscribed, ovoid, homogeneously hypoattenuating mass of the left adrenal gland, which is indeterminate.

The follow up CT revealed as follows:
Again seen in the anterior left hepatic lobe is a wedge-shaped subcapsular hypoattenuating lesion 3.5 cm in size. A smaller lesion with similar characteristics is seen in the inferior right hepatic lobe. There is a hypodense lesion in the left subdiaphragmatic location. This is 4.6 cm in size and demonstrates Hounsfield unit noncontrast 25, venous phase 27, delayed phase 26. There are no areas of nodular enhancement calcification or septation. This lesion abuts the pancreas tail and the left kidney and an adjacent loop of jejunum. Remaining solid abdominal organs unremarkable.

Ive had a full adrenal work up and so far it seems to be non functioning. My Vitamin D was low and my catecholamines were unable to be performed(according to quest, but they didn't specify why). My endocrinologist is referring me to a surgeon for resection regardless, but I'd like to get someones opinion The washout and size greater than 4cm is what has me concerned.
1 Responses
Avatar universal
Here is one sample algorithm for management of incidental adrenal masses:
https://www.jacr.org/action/showFullTextImages?pii=S1546-1440%2817%2930551-3

According to this flowchart, if indeterminate imaging features, greater than 4 cm, and no history of cancer, consider resection (consider biochemical assays to determine functional status and exclude pheochromocytoma; unable to be performed in your case). These recommendations are in agreement with your endocrinologist's recommendations.
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