This patient has diffuse metastases to the liver, which were found on biopsy to be small cell lung cancer. The adrenal glands are enlarged but still shaped like adrenal glands. Look for the right adrenal just posterior to the IVC and the left just anterior to the uppermost left kidney. Many types of tumors can produce excess ACTH, which can lead to Cushings syndrome and hypertrophy of the adrenal glands, as in this case.