Adrenal hemorrhage and hemorrhagic masses; diagnostic workup and imaging findings.

Adrenal hemorrhage (AH) is a rare condition. It can be traumatic or non-traumatic. Most common causes are septicemia, coagulopathy or bleeding diathesis, and underlying neoplasms. Other reported less common causes of AH are COVID-19 and neonatal stress. Clinical diagnosis of AH is challenging due to its non-specific presentation and occurrence in the setting of acute medical illness. Therefore, most cases are diagnosed incidentally on imaging. Having high clinical suspicion in the proper clinical setting for AH is crucial to avoid life-threatening adrenal insufficiency that occurs in 16-50% of patients with bilateral AH. We discuss the clinical situations that predispose to AH, review the imaging features on different imaging modalities, highlight a variety of clinical cases, imaging features that should be concerning for an underlying neoplasm, and outline the potential role of interventional radiology in management of AH.

Retroperitoneal extra-adrenal myelolipoma misdiagnosed as liposarcoma: A case report.

Myelolipomas are rare benign tumors that contain a mix of fatty and hematopoietic tissues. These tumors are frequently seen in the adrenal glands. While extra-adrenal myelolipomas are extremely rare, once identified, they are commonly found in the retroperitoneum--particularly the presacral region. Because of the fat content, these tumors can be easily mistaken for retroperitoneal liposarcomas. We are presenting a case of a 44-year-old female with a pathology proven case of retroperitoneal extra-adrenal myelolipoma that was initially diagnosed by imaging as a retroperitoneal liposarcoma. In this case report, the clinical presentation, imaging findings, operative details and histopathology features are illustrated.