Objective To investigate the enhancement pattern of adrenal cortical adenoma(ACA), and evaluate the common and uncommon contrast-enhanced ultrasonography(CEUS) features to improve the diagnostic accuracy. Methods 33 cases of histologically proved ACA were underwent conventional ultrasound and CEUS. The enhancement patterns were analyzed. Results 33 cases were unilateral and single lesion. 31 cases were hypoechoic, homogeneous echogenicity. 1 case presented heterogenous echogenicity and 1 case was with cystis changes. The maximal diameter of 26 cases <4 cm. No blood flow signal was found in 32 lesions. All cases had CEUS. 31 lesions were homogeneous enhanced and 2 cases were heterogenous. 26 masses exhibited slightly low or same peek intensity to surrounding liver or renal parenchyma. 5 cases presented no recordable contrast enhancement and 2 cases were remarkable enhanced. 29 lesions had nonspecific enhancement and 4 cases had peripheral to central contrast filling. Conclusion The common enhancement pattern of ACA was homogeneous with slightly low or same peek intensity to surrounding liver or renal parenchyma. The uncommon ACA features of CEUS included no recordable contrast enhancement, remarkable enhancement, centrpetal fill-in and heterogenous. Identification of the common CEUS enhancement patterns could improve the diagnostic ability of ACA. The diagnosis is difficult when the lesions enhanced in the pattern of centrpetal fill-in or heterogenous and still requires enhanced CT or biopsy.