<p>Anastomosing hemangioma (AH) of the adrenal gland is a rare benign vascular tumor that can closely mimic malignant lesions on imaging. We report the case of a 52-yearold male who presented with right upper abdominal pain and was found to have a 5 cm right adrenal mass suspicious for adrenocortical carcinoma on ultrasound and contrastenhanced CT. Endocrine evaluation was normal. The patient underwent laparoscopic adrenalectomy; intraoperatively the adrenal mass had dense adhesions to the right kidney, duodenum, and inferior vena cava. Histopathological examination revealed a well-circumscribed vascular lesion with irregular anastomosing blood-filled channels lined by hobnail endothelial cells, without atypia or mitoses, consistent with an anastomosing hemangioma. The patient’s postoperative course was uneventful. In the discussion, we review the literature on adrenal AH, which has only been reported in fewer than 25 cases to date. We discuss its epidemiology (typically middle-aged patients), imaging characteristics (often nonspecific, sometimes mimicking aggressive adrenal tumors), distinctive histological features, and management considerations. This case highlights the importance of recognizing adrenal AH as a benign entity in the differential diagnosis of adrenal masses to avoid overly aggressive treatment for what is a benign condition.</p>