Edited by ScholarGen MediAI Team

Executive Answer

An adrenal mass in a patient with known metastatic malignancy is not automatically an adrenal metastasis. In this case, a well-defined left adrenal mass measured approximately −59 HU on CT, strongly indicating macroscopic fat. MRI further demonstrated persistent high signal on in-phase and out-of-phase images with signal suppression on fat-suppressed sequences, supporting macroscopic rather than intracellular lipid. Diffusion-weighted imaging showed no definite restriction, and the lesion demonstrated no significant uptake on Cu-64 DOTATATE PET/CT. Taken together, these findings support adrenal myelolipoma, a benign fat-containing adrenal tumor, rather than metastatic neuroendocrine tumor.

Why This Case Matters

An adrenal mass can become diagnostically difficult when it appears in a patient who already has proven malignancy.

The clinical context can create a powerful assumption:

Known cancer + new adrenal mass = adrenal metastasis.

That reasoning is understandable, but it can be wrong.

Radiologic diagnosis requires two pieces of information to be integrated rather than allowing one to dominate the other:

The patient's oncologic context
The imaging phenotype of the adrenal lesion

This distinction is particularly important when a lesion demonstrates a highly characteristic tissue composition.

In this case, the patient was a man in his 40s who underwent contrast-enhanced CT of the abdomen and pelvis because of weight loss and right-sided abdominal pain. Imaging demonstrated a suspected colonic malignancy and multiple liver lesions. Pathologic evaluation established a gastrointestinal neuroendocrine tumor with liver metastases.

A left adrenal mass was also identified.

Because metastatic disease was already present, adrenal metastasis was an important diagnostic consideration.

However, the adrenal lesion contained a critical imaging clue: approximately −59 HU attenuation.

That single measurement fundamentally changed the diagnostic pathway.

Clinical Scenario

The patient presented with weight loss and right-sided abdominal pain.

Contrast-enhanced CT demonstrated:

A focal colonic mass suspicious for malignancy
Multiple liver lesions
A well-defined left adrenal mass
Macroscopic fat within the adrenal lesion, with attenuation of approximately −59 HU

The colonic and liver lesions were subsequently confirmed as a gastrointestinal neuroendocrine tumor with liver metastases.

The question therefore became:

Is the left adrenal lesion another manifestation of metastatic neuroendocrine tumor, or is it an unrelated benign adrenal lesion?

The answer depends primarily on the imaging phenotype.

The Most Important CT Finding: Macroscopic Fat

The most important imaging clue in this case is the presence of macroscopic fat within the adrenal mass.

The lesion measured approximately −59 HU on CT.

CT attenuation values below water and particularly negative attenuation values strongly suggest fat. When a clearly negative attenuation component is present within an adrenal mass, the radiologist should ask an important second question:

Is this intracellular lipid or macroscopic fat?

That distinction matters.

Lipid-rich adrenal adenomas can demonstrate low attenuation because of intracellular lipid. By contrast, adrenal myelolipomas characteristically contain macroscopic fat, representing mature adipose tissue that can be directly recognized on CT.

Therefore, a markedly negative attenuation value such as approximately −59 HU within a well-defined adrenal mass provides a major clue toward adrenal myelolipoma.

This is more informative than simply describing the lesion as a "low-density adrenal mass."

Radiology Pearl

Do not stop at "low attenuation." Determine what type of fat is present.

A low-attenuation adrenal lesion and a macroscopic-fat-containing adrenal lesion are not synonymous.

What Is an Adrenal Myelolipoma?

Adrenal myelolipoma is a benign adrenal tumor composed of two major tissue components:

Mature adipose tissue
Hematopoietic tissue

The exact pathogenesis is not completely established. Proposed mechanisms have included metaplastic changes of mesenchymal cells and chronic hormonal or adrenocorticotropic hormone-related stimulation.

Most adrenal myelolipomas are discovered incidentally during imaging performed for another clinical indication.

The lesion is generally benign, and a characteristic imaging appearance can often establish the diagnosis without biopsy.

This distinction becomes particularly valuable in patients with known malignancy because an incidental benign adrenal lesion can otherwise be mistaken for metastatic disease.

CT: The First Diagnostic Gatekeeper

CT is particularly useful for identifying the characteristic fat composition of adrenal myelolipoma.

In this case, the left adrenal lesion demonstrated:

A relatively well-defined margin
Macroscopic fat
Approximately −59 HU attenuation
No clearly described aggressive local invasion

The key point is that the composition of the lesion is more important than the mere presence of an adrenal mass in a cancer patient.

Figure 1. Axial Contrast-Enhanced CT

The axial contrast-enhanced CT image demonstrates a well-defined left adrenal mass containing markedly low-attenuation fat, measuring approximately −59 HU.

Radiologic interpretation: The macroscopic fat strongly supports adrenal myelolipoma.

Clinical significance: In a patient with metastatic neuroendocrine tumor, the presence of macroscopic fat argues against simply labeling the adrenal lesion as metastatic disease.

ALT text: Axial contrast-enhanced CT showing a well-defined left adrenal mass containing macroscopic fat with approximately −59 HU attenuation.

Coronal CT: Confirming Origin and Anatomic Relationships

Coronal reconstruction adds another important dimension to adrenal mass evaluation.

Figure 2. Coronal Contrast-Enhanced CT

The coronal CT image demonstrates the relatively well-defined left adrenal mass and its relationship to adjacent retroperitoneal structures.

Coronal imaging is particularly useful for confirming the apparent organ of origin and evaluating the relationship of the lesion to the kidney, vessels, and surrounding structures.

This is an important diagnostic principle:

A fat-containing retroperitoneal mass is not automatically an adrenal myelolipoma.

The radiologist must establish where the lesion originates.

Potential mimics include retroperitoneal lipomatous tumors and renal angiomyolipoma.

ALT text: Coronal contrast-enhanced CT demonstrating a well-defined left adrenal mass containing macroscopic fat.

Why MRI Adds Value

If CT already demonstrates convincing macroscopic fat, why perform MRI?

The answer is that MRI can provide additional tissue characterization.

MRI can help evaluate:

Fat distribution
Hematopoietic components
Hemorrhage
Necrosis
Enhancement
Diffusion characteristics
Anatomic relationships

In this case, MRI was particularly useful because the patient already had a proven gastrointestinal neuroendocrine tumor with liver metastases.

The clinical question was therefore not simply:

"Is there fat?"

It was:

"Does the entire imaging pattern remain compatible with a benign adrenal myelolipoma despite the patient's metastatic malignancy?"

The MRI findings supported that interpretation.

MRI and the Importance of Fat Suppression

The lesion demonstrated high signal on T1-weighted imaging, consistent with a fatty component.

More importantly, the lesion showed signal suppression on fat-suppressed sequences.

Figure 3. Contrast-Enhanced MRI

The contrast-enhanced MRI demonstrates a well-defined left adrenal lesion with high signal intensity on T2-weighted imaging and clearly defined multiplanar anatomy.

Because adrenal myelolipoma contains variable proportions of fat and hematopoietic tissue, the MRI appearance can be heterogeneous.

A high T2 signal should therefore not be interpreted in isolation as evidence of malignancy.

ALT text: Multiplanar contrast-enhanced MRI demonstrating a well-defined left adrenal mass with fatty components.

Chemical-Shift MRI: Intracellular Lipid vs Macroscopic Fat

One of the most useful concepts in adrenal imaging is the distinction between intracellular lipid and macroscopic fat.

Figure 4. Intracellular Lipid vs Macroscopic Fat

In this case:

T1-weighted imaging demonstrated high signal.
High signal persisted on in-phase imaging.
High signal also persisted on out-of-phase imaging.
Fat-suppressed imaging demonstrated signal reduction.

This pattern supports macroscopic fat.

Why?

In a lipid-rich adrenal adenoma, intracellular lipid can produce signal loss on out-of-phase chemical-shift imaging.

Macroscopic fat behaves differently. It represents physically larger collections of adipose tissue and does not simply disappear because of chemical-shift effects.

Therefore:

Out-of-phase signal loss suggests intracellular lipid, whereas persistent high signal with suppression on fat-suppressed imaging supports macroscopic fat.

This distinction is central to differentiating adrenal adenoma from adrenal myelolipoma.

DWI: Useful, but Not a Stand-Alone Diagnosis

Diffusion-weighted imaging demonstrated no definite diffusion restriction.

This finding is compatible with the benign imaging pattern in this case.

However, DWI should not be used as an isolated diagnostic test for adrenal myelolipoma.

A common interpretive error is:

No diffusion restriction = benign.

That is too simplistic.

DWI is supportive information. The stronger evidence comes from the overall pattern:

macroscopic fat + fat suppression + well-defined morphology + no definite diffusion restriction

The diagnosis should be based on the integrated imaging phenotype rather than one MRI sequence.

Cu-64 DOTATATE PET/CT: Functional Imaging as a Supporting Test

The patient had a gastrointestinal neuroendocrine tumor with liver metastases, making functional imaging particularly relevant.

Cu-64 DOTATATE PET/CT can evaluate somatostatin receptor expression and can therefore contribute to assessment of neuroendocrine tumor disease.

Figure 5. Axial Cu-64 DOTATATE PET/CT

The left adrenal mass demonstrated no significant Cu-64 DOTATATE uptake.

This finding reduces the likelihood that the adrenal lesion represents a somatostatin-receptor-positive metastatic neuroendocrine tumor.

However, PET negativity should not be used alone to establish benignity.

The strength of the PET finding comes from its combination with the structural imaging evidence.

The diagnostic reasoning is therefore:

CT identifies macroscopic fat → MRI confirms the fatty nature → DWI provides supportive information → DOTATATE PET/CT does not demonstrate significant uptake.

Together, these findings support adrenal myelolipoma.

Figure 6. Coronal Cu-64 DOTATATE PET/CT

The coronal PET/CT image demonstrates no significant tracer uptake within the left adrenal mass.

Clinical interpretation: Functional imaging does not demonstrate the expected pattern of an active somatostatin-receptor-positive neuroendocrine metastasis.

ALT text: Coronal Cu-64 DOTATATE PET/CT showing no significant tracer uptake in a left adrenal mass.

Why Adrenal Metastasis Must Still Be Considered

The patient already had metastatic malignancy.

Adrenal metastases can occur in a variety of cancers, including lung cancer, breast cancer, renal cell carcinoma, melanoma, and other malignancies.

Therefore, dismissing an adrenal mass simply because it contains an unusual component would also be inappropriate.

The correct approach is not:

"The patient has cancer, so this must be metastasis."

Nor is it:

"The lesion contains fat, so malignancy is impossible."

Instead, ask:

Does the adrenal lesion demonstrate the imaging phenotype expected for metastasis?

In this case, the answer is unfavorable for metastatic disease because the lesion demonstrates a characteristic macroscopic-fat pattern.

Differential Diagnosis of a Fat-Containing Adrenal Mass

1. Adrenal Myelolipoma

This is the leading diagnosis in the present case.

Typical clues include:

Macroscopic fat
Negative CT attenuation
Well-defined morphology
Fat suppression on MRI
Variable hematopoietic components
Generally benign imaging appearance

The combination of macroscopic fat and adrenal origin is particularly characteristic.

2. Lipid-Rich Adrenal Adenoma

Adrenal adenoma is one of the most common adrenal tumors.

A lipid-rich adenoma may demonstrate low attenuation on noncontrast CT because of intracellular lipid.

However, the type of fat differs.

Adenoma → intracellular lipid

Myelolipoma → macroscopic fat

Chemical-shift MRI can therefore be helpful when the CT appearance is not definitive.

3. Adrenal Metastasis

Metastasis must remain in the differential when a patient has known malignancy.

However, typical adrenal metastases are soft-tissue lesions rather than lesions dominated by macroscopic fat.

Therefore, the presence of clear macroscopic fat substantially changes the differential diagnosis.

4. Adrenocortical Carcinoma

Adrenocortical carcinoma can present as a large, heterogeneous adrenal mass with necrosis, hemorrhage, irregular enhancement, and local invasion.

A classic macroscopic fat-containing lesion has a different imaging phenotype.

However, atypical lesions may require broader differential consideration.

5. Pheochromocytoma

Pheochromocytomas can show high T2 signal and variable enhancement.

Macroscopic fat is not a typical feature.

Importantly, suspected pheochromocytoma also requires appropriate biochemical evaluation rather than imaging interpretation alone.

6. Retroperitoneal Liposarcoma

A retroperitoneal liposarcoma may contain substantial fat.

The critical issue is determining the lesion's true anatomic origin.

A large fatty retroperitoneal mass should not automatically be assigned to the adrenal gland.

7. Renal Angiomyolipoma

Renal angiomyolipoma can also contain macroscopic fat.

Therefore, the first question should always include:

Where did the lesion originate?

Confirming adrenal origin is essential.

A Practical Diagnostic Algorithm for Adrenal Masses

When an adrenal mass is identified in a patient with known malignancy, a structured approach can reduce diagnostic error.

Step 1 — Confirm the Organ of Origin

Is the lesion truly arising from the adrenal gland?

Consider:

Adrenal
Kidney
Retroperitoneum
Adjacent structures

Step 2 — Identify the Type of Fat

If fat is present, determine whether it is:

Intracellular lipid
Macroscopic fat

Step 3 — Evaluate the Margins

Is the lesion:

Well-defined?
Smooth?
Infiltrative?
Irregular?

Step 4 — Assess Enhancement

Evaluate:

Homogeneity
Heterogeneity
Necrosis
Hemorrhage
Abnormal enhancement

Step 5 — Review DWI

Determine whether definite diffusion restriction is present.

Use this as supportive information rather than a stand-alone diagnostic criterion.

Step 6 — Compare With the Known Malignancy

Ask:

Does the adrenal lesion resemble the known primary tumor or its metastatic pattern?

Step 7 — Integrate Functional Imaging When Available

If PET/CT is performed, determine whether tracer uptake corresponds to the suspected metastatic process.

This integrated approach is more reliable than allowing the patient's cancer history to determine the diagnosis before the lesion itself is characterized.

Diagnostic Risk: The "Cancer Means Metastasis" Trap

This case illustrates an important form of diagnostic risk: anchoring on the known malignancy.

Once metastatic cancer is established, every new lesion can appear suspicious.

That creates a potential cognitive pathway:

Known cancer → new lesion → presumed metastasis → imaging interpretation adjusted to fit the assumption.

The safer radiologic approach is:

Known cancer → characterize new lesion → determine imaging phenotype → compare with metastatic pattern → integrate clinical context.

The distinction is subtle but important.

The patient's history should influence the differential diagnosis.

It should not replace lesion characterization.

This is particularly relevant in high-volume radiology environments, where multiple abnormalities may be reviewed under significant time pressure.

The Clinical Consequence of Correct Characterization

The value of recognizing adrenal myelolipoma is not merely academic.

If a lesion has a characteristic benign imaging appearance, unnecessary invasive procedures may potentially be avoided.

That can mean avoiding:

Unnecessary biopsy
Additional diagnostic procedures
Unnecessary surgery
Additional imaging prompted solely by uncertainty

The goal is not to minimize evaluation.

The goal is to match the intensity of evaluation to the actual diagnostic uncertainty.

A confidently characterized benign lesion should not automatically trigger the same pathway as an indeterminate or aggressive adrenal mass.

Does Every Adrenal Myelolipoma Require Surgery?

No.

A typical asymptomatic adrenal myelolipoma generally does not require immediate surgical resection solely because it exists.

Management depends on:

Symptoms
Tumor size
Growth
Hemorrhage
Mass effect
Imaging certainty
Possible hormonal activity
Whether malignancy can be reasonably excluded

Large lesions can produce abdominal, flank, or back pain through mass effect and may carry a greater risk of hemorrhagic complications.

Therefore, the correct clinical message is not:

"Benign means no follow-up is ever necessary."

Instead:

"Benign imaging features should prevent unnecessary intervention, while symptoms, growth, hemorrhage, size, and diagnostic uncertainty should guide management."

When Should Surgery Be Considered?

Potential reasons for considering surgical treatment include:

Persistent abdominal or flank pain
Compression of adjacent organs
Acute hemorrhage
Significant growth
Very large tumor size
Atypical imaging features
Inability to confidently exclude malignancy
Associated functional adrenal disease

Historical literature has proposed size thresholds for surgery, but a single absolute size threshold should not replace clinical judgment.

The decision should integrate the lesion's size, symptoms, growth pattern, hemorrhagic risk, imaging certainty, and overall clinical context.

An Important Clinical Trap: Is the Pain Actually Coming From the Adrenal Mass?

This case provides another valuable lesson.

The patient had right-sided abdominal pain.

The adrenal lesion was on the left.

At the same time, the patient had a colonic mass and multiple liver lesions associated with metastatic gastrointestinal neuroendocrine tumor.

Therefore, the existence of an adrenal mass should not automatically be used to explain the patient's symptoms.

This is an important general principle:

Finding a lesion and identifying the cause of symptoms are two different diagnostic questions.

Radiologists should describe clinically relevant abnormalities, but should avoid forcing every abnormality into a single causal explanation.

CT vs MRI: Which Is More Important?

The answer is not simply CT or MRI.

They provide complementary information.

CT

CT is particularly useful for:

Detecting macroscopic fat
Measuring attenuation
Evaluating calcification
Assessing hemorrhage
Evaluating surrounding structures
Providing rapid abdominal imaging
Assessing the lesion in the context of staging

For adrenal myelolipoma, direct identification of macroscopic fat is one of CT's greatest strengths.

MRI

MRI provides:

Superior soft-tissue contrast
Multiplanar characterization
Fat-suppressed sequences
Chemical-shift imaging
Diffusion-weighted imaging
Assessment of hemorrhagic components

When CT provides a clear diagnosis, MRI may not always be necessary.

When the lesion is complex or its tissue composition remains uncertain, MRI can provide additional characterization.

AI Perspective: Where Could Medical AI Help?

This case also illustrates a potential role for AI in radiology—not as a replacement for diagnosis, but as a second-reader and workflow support system.

A future or appropriately validated imaging AI system could potentially assist with:

Detection of adrenal masses
Automated localization of adrenal lesions
Measurement of lesion size
CT attenuation analysis
Identification of macroscopic fat
Comparison with prior examinations
Structured reporting
Cross-modality correlation
Flagging potentially discordant findings

For example, an AI-assisted workflow might identify an adrenal mass and automatically provide:

Location → Size → Mean/representative attenuation → Fat characteristics → Prior comparison

This could help reduce the chance that a small incidental adrenal lesion is overlooked during complex oncologic staging.

However, AI should not independently conclude:

"This is definitely benign."

The system would need to account for:

False negatives
False positives
Image quality
Domain shift
Dataset bias
Unexpected pathology
Anatomical mislocalization
Automation bias

Human radiologist oversight remains essential.

AI Workflow: From DICOM to Clinical Decision Support

In an enterprise imaging environment, a conceptual workflow could be:

DICOM → PACS → AI Orchestration → Adrenal Detection / Characterization Model → CT Attenuation and Fat Analysis → PACS Visualization → Radiologist Review → RIS → EHR/EMR →Clinical Decision Support

For a case such as this, the most valuable AI contribution would not necessarily be simply detecting the adrenal mass.

The higher-value opportunity would be integrating imaging features into a clinically meaningful structured interpretation.

For example:

Left adrenal mass with macroscopic fat, compatible with adrenal myelolipoma; correlate with clinical and prior imaging findings.

Such assistance could improve consistency and reduce omission risk, but the final interpretation remains the responsibility of the radiologist.

Healthcare Workflow Implication

This case demonstrates why radiology AI should not be evaluated solely by detection accuracy.

A clinically useful system should also be assessed in terms of:

Detection
Characterization
Prior-study comparison
Workflow integration
Reporting support
False-positive burden
Alert fatigue
Radiologist adoption
Turnaround time
Human oversight

An AI system that identifies every possible abnormality but generates excessive false-positive alerts may increase rather than reduce cognitive burden.

The practical objective should be:

better information at the right point in the radiology workflow.

Practical Radiology Pearls

Pearl 1: A known malignancy does not make every new adrenal mass a metastasis.
Pearl 2: Macroscopic fat is a major diagnostic clue for adrenal myelolipoma.
Pearl 3: Approximately −59 HU within a well-defined adrenal mass strongly supports the presence of macroscopic fat.
Pearl 4: Distinguish intracellular lipid from macroscopic fat.
Pearl 5: Chemical-shift MRI and fat-suppressed sequences can help characterize the nature of fat.
Pearl 6: DWI is supportive, not definitive.
Pearl 7: Negative DOTATATE uptake can support the interpretation in the appropriate clinical context, but PET negativity alone does not establish benignity.
Pearl 8: Always confirm the organ of origin of a fat-containing retroperitoneal mass.
Pearl 9: A benign imaging diagnosis does not automatically mean that symptoms are caused by the lesion.
Pearl 10: When imaging is characteristic, and the patient is asymptomatic, unnecessary biopsy or surgery should generally be avoided.

Common Pitfalls

Pitfall 1: Anchoring on the Known Cancer

"Patient has metastatic cancer, therefore adrenal mass is metastatic."

Correction: Characterize the adrenal lesion independently.

Pitfall 2: Calling Every Low-Attenuation Adrenal Mass an Adenoma

Low attenuation does not automatically mean intracellular lipid.

Correction: Determine whether the lesion contains macroscopic fat.

Pitfall 3: Using One MRI Sequence in Isolation

A single high T2 signal or a single DWI finding should not determine the diagnosis.

Correction: Interpret the multiparametric MRI pattern.

Pitfall 4: Treating PET as the Final Answer

Absence of DOTATATE uptake does not independently prove benignity.

Correction: Integrate PET with CT and MRI morphology.

Pitfall 5: Ignoring Organ of Origin

A retroperitoneal fatty mass can have several possible origins.

Correction: Establish whether the lesion arises from the adrenal gland, kidney, or retroperitoneum.

Pitfall 6: Assuming the Incidental Lesion Causes the Symptoms

The presence of an adrenal mass does not establish causality.

Correction: Correlate the lesion with symptoms, laterality, size, mass effect, and the other abnormalities identified in the patient.

Frequently Asked Questions

What is the key CT finding of adrenal myelolipoma?

The key finding is macroscopic fat within an adrenal mass, typically demonstrated by markedly negative CT attenuation. In this case, the lesion measured approximately −59 HU.

How can adrenal myelolipoma be distinguished from a lipid-rich adrenal adenoma?

The distinction is primarily based on the type of lipid. Adenomas commonly contain intracellular lipid, whereas myelolipomas contain macroscopic fat. Chemical-shift MRI and fat-suppressed imaging can help distinguish these patterns.

Can adrenal metastasis contain fat?

Macroscopic fat is not a typical imaging feature of conventional adrenal metastasis. Therefore, convincing macroscopic fat should prompt consideration of a benign fat-containing adrenal lesion such as myelolipoma, while the complete imaging pattern and clinical context remain important.

Does adrenal myelolipoma require surgery?

Not necessarily. A characteristic, asymptomatic lesion generally does not require immediate resection. Surgery may be considered when symptoms, hemorrhage, substantial growth, very large size, atypical imaging features, or diagnostic uncertainty are present.

Is MRI always necessary after CT?

No. When CT demonstrates convincing macroscopic fat and a characteristic benign appearance, the diagnosis may be sufficiently supported. MRI becomes particularly useful when the lesion is complex or further tissue characterization is required.

What does no DOTATATE uptake mean in this case?

The absence of significant Cu-64 DOTATATE uptake in the adrenal lesion reduces the likelihood that it represents a somatostatin-receptor-positive neuroendocrine tumor metastasis. It is supportive rather than independently diagnostic.

Can a benign adrenal myelolipoma cause abdominal pain?

Large lesions can produce abdominal, flank, or back symptoms through mass effect and can rarely be associated with hemorrhage. However, the presence of a myelolipoma does not automatically establish it as the cause of a patient's symptoms.

What is the most important diagnostic mistake to avoid?

The key mistake is allowing the patient's known malignancy to override the lesion's actual imaging phenotype.

Key Takeaways

A known malignancy does not make every adrenal mass metastatic.
Macroscopic fat is the central imaging clue to adrenal myelolipoma.
Approximately −59 HU strongly supports macroscopic fat in this case.
MRI fat suppression helps confirm the fatty nature of the lesion.
Chemical-shift MRI helps distinguish intracellular lipid from macroscopic fat.
DWI should be interpreted as supportive rather than definitive evidence.
Absence of Cu-64 DOTATATE uptake can reduce concern for neuroendocrine metastasis but should not be interpreted in isolation.
The organ of origin must be confirmed in every fat-containing retroperitoneal mass.
Characteristic benign imaging findings can help prevent unnecessary invasive procedures.
Radiologic diagnosis is strongest when clinical context and lesion phenotype are integrated rather than when either is used alone.

The One-Sentence Lesson From This Case

In a patient with metastatic cancer, an adrenal mass should not be called metastatic disease until its imaging phenotype has been carefully characterized—and macroscopic fat may be the decisive clue that reveals an adrenal myelolipoma instead.

Continue Learning

If you want to understand adrenal imaging more deeply, continue with related topics such as:

References

Calissendorff J, Juhlin CC, Sundin A, Bancos I, Falhammar H. Adrenal myelolipomas. Lancet Diabetes Endocrinol. 2021;9(11):767–775. doi:10.1016/S2213-8587(21)00178-9.
Decmann Á, Perge P, Tóth M, Igaz P. Adrenal myelolipoma: a comprehensive review. Endocrine. 2018;59(1):7–15. doi:10.1007/s12020-017-1473-4.
Schieda N, Siegelman ES. Update on CT and MRI of adrenal nodules. AJR Am J Roentgenol. 2017;208(6). doi:10.2214/AJR.16.17758.
Albano D, Agnello F, Midiri F, et al. Imaging features of adrenal masses. Insights Imaging. 2019;10(1). doi:10.1186/s13244-019-0688-8.
Wang F, Liu J, Zhang R, et al. CT and MRI of adrenal gland pathologies. Quant Imaging Med Surg. 2018;8(8):853–875. doi:10.21037/qims.2018.09.13.
Corwin MT, Schieda N, Remer EM, Caoili EM. Management of incidental adrenal nodules: a survey of abdominal radiologists conducted by the Society of Abdominal Radiology Disease-Focused Panel on Adrenal Neoplasms. Abdom Radiol. 2022;47(4):1360–1368. doi:10.1007/s00261-022-03439-y.
Gershuni VM, Bittner JG IV, Moley JF, Brunt LM. Adrenal myelolipoma: operative indications and outcomes. J Laparoendosc Adv Surg Tech A. 2014;24(1):8–12. doi:10.1089/lap.2013.0411.
Fassnacht M, Tsagarakis S, Terzolo M, et al. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas. Eur J Endocrinol. 2023;189(1):G1–G42. doi:10.1093/ejendo/lvad066.
Campbell MJ, Obasi M, Wu B, Corwin MT, Fananapazir G. The radiographically diagnosed adrenal myelolipoma: what do we really know? Endocrine. 2017;58(2):289–294. doi:10.1007/s12020-017-1410-6.

Medical Disclaimer

This article is intended for medical education and informational purposes only. It does not replace professional medical diagnosis, treatment, or individualized clinical judgment. Patients should discuss their symptoms, imaging findings, and treatment options with an appropriately qualified healthcare professional.

Adrenal Myelolipoma in a Patient With Metastatic Neuroendocrine Tumor: The CT Finding That Prevents a False Diagnosis of Adrenal Metastasis