ObjectiveTo investigate the CT and pathological findings of adrenal leiomyosarcoma, so as to improve the accuracy of diagnosis.MethodsThe clinical data of patients with adrenal leiomyosarcoma who were confirmed with surgery and pathology in West China Hospital, Sichuan University between August 2009 and January 2019 were retrospectively analyzed. Patients without pre-operation CT examination were excluded. The CT imaging features of the disease, including the location, size, shape, enhanced features, surrounding structures and metastasis of adrenal leiomyosarcoma were evaluated on CT images, respectively.ResultsFinally 5 patients were included. All of them had left single lesion. Enhanced CT features delineated large masses with well-defined but irregular boundaries, multicentric necrosis involving both the center and edge, continuous increased enhancement of the non-necrotic area, and cross-section of neovascularization or needle-tip vessels in the tumors. Among the 5 patients, 2 had postoperative recurrence and 3 lost follow-up.ConclusionsPrimary adrenal leiomyosarcoma is rare. Adrenal leiomyosarcoma could be correctly diagnosed with CT enhanced examination, which are helpful for making surgical strategies.