Presentation
Male patient with non specific loin pain.
Patient Data
A right hypochondrial well-defined echogenic mass lesion of predominant fat echogenicity is seen insinuating between the liver and upper pole of right kidney showing no internal vascularity.
Right suprarenal well defined oblong-shaped fat-containing soft tissue mass lesion displaying gross hypodense fatty attenuation (macroscopic fat) as well as minimal heterogeneous soft tissue attenuation showing subtle enhancement. Clear surrounding fat planes are noted with no evidence of invasive changes.
Normal appearance of the left adrenal gland.
Differential Diagnosis:
Case Discussion
The described lesion shows almost most of the typical imaging criteria of the classic adrenal myelolipoma. It is a benign adrenal tumor that is usually incidentally noted with macroscopic fat content. It can be bilateral or unilateral with a right side predilection. It is often hormonally inactive lesion
On CT, the presence of fat densities in a benign-looking suprarenal mass lesion is the key for the diagnosis. The non-fatty soft tissue component usually enhances due to hematopoietic tissue composition.
Other suprarenal neoplasms can show macroscopic fat, but fat-containing malignancies of the adrenal gland are exceedingly rare, like fat-containing adrenal cortical adenoma/carcinoma. Other fat-containing retroperitoneal tumors also could be regarded like lipomas, angiomyolipomas, mature teratomas, and liposarcomas that should be differentiated so.
Percutaneous fine-needle aspiration by US or CT guidance can confirm the diagnosis.
Case contributed by Dr. Reem Yehia
Ultrasound study contributed by Dr. Somia Elbadawy
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