[Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Baskıdaki Makaleler: UTD-99457 | DOI: 10.14744/tjtes.2019.UTD-99457  

Hemorrhagic Adrenal Myelolipoma after Trauma to Left Adrenal Gland: A Case Report

Tse-Hao Chen1, pei fang lai2, Yung-hsiang Hsu3
1Division of Medical Education, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
2Department of Emergency Medicine, Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
3Department of Pathology, Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan

Myelolipomas are rare benign tumors comprised of mature adipose tissue and hematopoietic elements. Adrenal myelolipomas associated with traumatic adrenal injury are relatively rare and less common on the left due to the limited size and well-protected position of the gland.
A 59-year-old female admitted to the emergency department with intermittent left flank pain radiating to the left abdomen after falling from the bed 6 hours earlier. Her vital signs were stable, and she had tenderness over the left flank area and left abdomen. Her initial hemoglobin level was 12.9 g/dL. Bedside focused assessment with sonography for trauma revealed unclear left kidney margins. Contrast abdominal computed tomography (CT) revealed a space-occupying mass, 11.6 × 10.4 × 8.8 cm in dimension, in the left suprarenal region with active bleeding in the lower pole. Angiography did not reveal any active contrast medium extravasation. CT-guided biopsy was well performed concomitantly with angiography. Pathological assessment of the biopsy specimen revealed the presence of mostly adipose tissue with few erythrocytes and leukocytes. She was diagnosed with adrenal myelolipoma and admitted to urology ward for left adrenalectomy with tumor resection.
Traumatic adrenal injury, an unusual presentation of adrenal myelolipoma incidentally found in less than 5% of all abdominal blunt injuries, should be considered in cases of bleeding with trauma to the flank for prompt treatment.

Keywords: adrenal myelolipoma, traumatic adrenal Injury, adrenal emergency, incidentaloma, case report

Sorumlu Yazar: pei fang lai, Taiwan

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