What is the typical appearance of an adrenal cortical adenoma when the mass is less than 4cm?

An adrenal cortical adenoma typically presents as a normal appearance on imaging studies, especially when the mass is less than 4 cm in size. These adenomas are often small, benign tumors that do not alter the surrounding structure of the adrenal gland significantly. Consequently, when viewed through imaging modalities such as ultrasound or CT scans, they may not exhibit obvious alterations, and hence may appear 'normal' or without associated abnormalities.

Smaller adenomas (under 4 cm) generally do not show significant vascularity or aggressive features characteristic of malignant tumors. This is crucial in distinguishing benign from potentially malignant masses in the adrenal glands. The lack of hypervascularity is particularly relevant, as malignant adrenal masses tend to have increased blood flow due to their aggressive nature and higher metabolic activity.

Also, the appearance of such adenomas is not hypoechoic, which would suggest a solid mass with lower echogenicity compared to the surrounding tissue, but in the case of small adrenal cortical adenomas, this does not typically apply. Thus, the assessment of a normal appearance aligns with the established understanding of these small adrenal tumors.

In summary, when evaluating a small adrenal cortical adenoma, it is expected to have a normal appearance on imaging, demonstrating that it does