Answer for BIR CoW 30 July 2023
Adrenal myelolipoma
Findings
Well defined lesion which is T1 isointense to omental fat and T2 heterointense showing incomplete suppression on fat suppression images, superior to right kidney showing well defined fat plane between the lesion and right kidney
Discussion
Rare, benign and usually asymptomatic characterised by the predominance of mature adipocytes 10% of patients with adrenal myelolipoma have congenital adrenal hyperplasia Larger lesions (typically over 4 cm in size) can present with an acute retroperitoneal haemorrhage Rare, benign and usually asymptomatic characterised by the predominance of mature adipocytes 10% of patients with adrenal myelolipoma have congenital adrenal hyperplasia Larger lesions (typically over 4 cm in size) can present with an acute retroperitoneal haemorrhage USG - heterogeneous mass of mixed hyper- and hypoechoic components CT - The typical adrenal myelolipoma appears as an adrenal lesion with fat-containing components. The mass is usually relatively well circumscribed MRI T1: typically hyperintense due to fat contents T1 (FS): typically shows fat suppression T2: generally intermediate to hyperintense but can sometimes vary depending on contents (especially blood products) in and out of phase: in masses with mixed components, out of phase imaging may demonstrate signal loss as the microscopic fat cells usually have little intracellular water
Findings
Well defined lesion which is T1 isointense to omental fat and T2 heterointense showing incomplete suppression on fat suppression images, superior to right kidney showing well defined fat plane between the lesion and right kidney
Discussion
Rare, benign and usually asymptomatic characterised by the predominance of mature adipocytes 10% of patients with adrenal myelolipoma have congenital adrenal hyperplasia Larger lesions (typically over 4 cm in size) can present with an acute retroperitoneal haemorrhage Rare, benign and usually asymptomatic characterised by the predominance of mature adipocytes 10% of patients with adrenal myelolipoma have congenital adrenal hyperplasia Larger lesions (typically over 4 cm in size) can present with an acute retroperitoneal haemorrhage USG - heterogeneous mass of mixed hyper- and hypoechoic components CT - The typical adrenal myelolipoma appears as an adrenal lesion with fat-containing components. The mass is usually relatively well circumscribed MRI T1: typically hyperintense due to fat contents T1 (FS): typically shows fat suppression T2: generally intermediate to hyperintense but can sometimes vary depending on contents (especially blood products) in and out of phase: in masses with mixed components, out of phase imaging may demonstrate signal loss as the microscopic fat cells usually have little intracellular water
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!