Adrenal cysts are rare and form a heterogeneous group of lesions that includes (a) parasitic cysts, (b) epithelial cysts, (c) pseudocysts, and (d) endothelial cysts. There is evidence (immunohistochemical and ultrastructural) that both pseudocysts and endothelial cysts are variants of vascular cysts. Adrenal vascular cysts account for 84% of adrenal cysts. They are more common in women and present clinically with abdominal pain or are incidental findings. Their imaging features are not specific. Grossly, both types of adrenal vascular cysts are encapsulated. Pseudocysts are unilocular, thick-walled, and devoid of endothelial lining, whereas endothelial cysts are thin-walled, multilocular, and lined by endothelium. Adrenal vascular cysts probably originate from a preexisting vascular hamartoma. The treatment of choice is surgical excision. The prognosis is excellent.