Adrenal myelolipoma and beaver tail liver

Case contributed by Dr Muhammad Shoyab

Presentation

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

Patient Data

Age: 50 years
Gender: Male
CT

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.

PlayAdd to Share

Case information

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