Spontaneous haematoma associated with a small adrenal myelolipoma: transarterial embolisation approach

Adrenal myelolipomas are rare benign tumours, usually asymptomatic and discovered incidentally. Haemorrhage is an uncommon complication, typically associated with larger lesions. We present the case of a man in his 50s, with no history of trauma or antithrombotic therapy, who presented to the emergency department with acute low back pain. Contrast-enhanced CT revealed a right adrenal haematoma measuring 5 cm with active intralesional bleeding, associated with retroperitoneal and subcapsular hepatic haematoma. He underwent successful transarterial embolisation. Follow-up MRI showed a 3.8 cm lesion with internal fat content, consistent with an adrenal myelolipoma, and progressive reabsorption of the haematomas. This case highlights the potential for significant spontaneous haemorrhage in small adrenal myelolipomas and illustrates the use of transarterial embolisation as a minimally invasive management option.