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Adrenal cysts are rare lesions that are usually found incidentally on imaging performed for other reasons.

Epidemiology

Adrenal cysts are reported to be rare with an incidence of <1% .

Clinical presentation

Patients can present with pain or swelling, although a significant portion (~40%) are incidental findings .

Pathology

Adrenal cysts can be divided into four categories :

Radiographic features

US

Usually thin-walled cystic lesions with anechoic content and posterior beam enhancement. Internal mobile echoes might be seen.

CT

Small adrenal cysts may be difficult to differentiate from adrenal adenomas on unenhanced CT as they may both have densities in the pure fluid range, i.e. -10 to +10. However on post-contrast CT adrenal adenomas tend to enhance, whereas cysts do not .

MRI

MRI is commonly reserved for those equivocal cases on CT and confirms fluid within the cyst (bright T2 signal) .

Differential diagnosis

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