Abstract
Adrenal incidentalomas are increasingly identified through advanced imaging, posing diagnostic challenges due to their varied benign and malignant nature. We present the case of a 29-year-old male who, during evaluation for left renal colic, was found to have a 5.5 cm heterogeneous right adrenal mass on non-contrast CT, initially suggestive of a myelolipoma. Subsequent contrast-enhanced CT supported this diagnosis. However, due to the size of the mass and potential complications, the patient underwent a robotic-assisted adrenalectomy. Histopathological examination unexpectedly revealed a 6.5 cm adrenal ganglioneuroma. This case highlights the difficulties in accurately diagnosing adrenal incidentalomas based solely on imaging, as the features of ganglioneuromas and myelolipomas can occasionally overlap significantly. Ultimately, while imaging plays a critical role in initial assessment, definitive diagnosis often requires histological analysis, underscoring the challenges posed by adrenal incidentalomas in clinical practice.