Primary adrenal lymphoma (PAL) is a rare neoplastic disease. Most of the patients are elderly men with bilateral adrenal masses with no extra-adrenal involvement. The most common presenting symptoms of patients with PAL are fever, weight loss, lumbar pain and symptoms of adrenal insufficiency. The prognosis of patients with PAL is poor. Many patients with PAL die due to tumor recurrence or severe infections within the first year. The preoperative diagnosis of PAL is still problematic because of its nonspecific clinical presentation and imaging findings. This report presents ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography findings of three patients with primary adrenal lymphoma.