A 49-year-old white man presented to an emergency department with right upper abdominal pain and shortness of breath. He was diagnosed with a 14.8 cm right adrenal mass. Imaging features suggested a myelolipoma with intralesional hemorrhage. There was an attempt at angioembolization in interventional radiology, which was unsuccessful.
The patient underwent an adrenal metabolic workup, which was negative. Computed tomography of the chest showed a reactive right pleural effusion and no evidence of metastatic disease (Figure 1).
Due to persistent pain, the large size, and unsuccessful embolization attempt, the patient elected to proceed with an open right adrenalectomy for definitive treatment. Final pathology confirmed a benign myelolipoma. His recovery was uneventful.