Adrenal myelolipoma and beaver tail liver

Case contributed by Dr Muhammad Shoyab


Cough for 2 days; chest pain on coughing. No hormonal symptoms.

Patient Data

Age: 50 years
Gender: Male

CT Chest

Left lobe of liver elongated between spleen and left hemidiaphragm: beaver tail liver.

Oval lesion (1 cm) of macroscopic fat density (-78 HU) at anterior limb of right adrenal gland: myelolipoma.

Large triangular pads of fat density at both pericardiophrenic angles: pericardial fat pads.

Enlarged mediastinal lymph nodes at right lower paratracheal (4R), subaortic (5) and para-aortic (6) stations.

Case Discussion

Presence of true/macroscopic fat density (-30 to -90 HU) in an adrenal mass is diagnostic of myelolipoma, and no further workup is required. In the present case, the adrenal mass has densities close to -80 HU.

Nonetheless, the first differential for adrenal masses is adenoma, 80% of which are lipid-rich. CT densities of lipid-rich adrenal adenomas range around -15 HU.

Beaver tail liver is a normal anatomic variant. Its only major implication is that it may be more prone to injury by blunt abdominal trauma than the rest of the liver.

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Case information

rID: 86201
Published: 25th Jan 2021
Last edited: 27th Jan 2021
Inclusion in quiz mode: Included