Identification of macroscopic fat within an adrenal mass is usually diagnosed as benign myelolipoma, thereby avoiding unnecessary radical surgery. However, macroscopic fat-containing adrenocortical carcinomas have occasionally been reported.We report a case of macroscopic fat-containing adrenocortical carcinoma. The lesion was depicted on CT and MR as macroscopic fat-containing a large mass with patchy peripheral heterogeneous enhancement. Therefore, adrenocortical carcinoma should be included as one of the rare causes of macroscopic fat-containing an adrenal mass.