Introduction The adrenal hemangioma, a rare benign vascular tumour, is often detected incidentally through abdominal imaging. The incidental nature and radiological discordance can pose a diagnostic challenge to rule out malignancy given their overlapping imaging features. Methods We present a 61-year-old female who presented with an incidental finding of a right sided non-functional 9.5cm adrenal mass on CT abdominal imaging, suspicious of adrenocortical carcinoma. An MRI scan demonstrated heterogenous T1 and T2 signal with nodular peripheral enhancement suggestive of an adrenal haemangioma. A PET scan did not demonstrate increased metabolic activity or distant metastases, and a red cell scan had findings atypical for a haemangioma. A literature review was conducted using Pubmed, Medline and Embase. Results An adrenalectomy was performed with features of dystrophic calcifications and evidence of previous haemorrhage with reorganisation on histopathology. There were 78 cases reported with a median age of 64 years. Almost all were incidental findings and open adrenalectomy was most commonly performed. Conclusion The presence of an adrenal incidentaloma with disconcordant radiological features proves to be a diagnostic conundrum for the clinician. In the setting of contradictory radiology and mass size, we recommend adrenalectomy for definitive diagnosis of an adrenal haemangioma and exclusion of malignancy.