Presacral myelolipoma: a case report and review of imaging findings

Abstract

Extra-adrenal myelolipoma is a relatively rare entity, with fewer than 50 cases reported in literature.  We present a case of a 79 year-old female who presented for evaluation of hip fracture following trauma, where a lobulated presacral mass with mixed fat/soft tissue attenuation was incidentally seen on initial bone algorithm pelvic CT.  Subsequent MRI showed signal characteristics of a lesion with mixed fat and soft tissue composition.  The lesion demonstrated stability on follow-up imaging.  An elective surgical resection was performed which yielded a grossly fatty mass. The diagnosis of presacral myelolipoma was confirmed on microscopic examination.  Following description of our case, we conduct a literature review of the imaging characteristics, diagnosis, and treatment of presacral myelolipoma.