Abstract
Adrenal myelolipomas are rare, hormonally silent, adipose and myeloid-containing lesions that are mostly asymptomatic. If they do present it is usually with mass-related flank pain or spontaneous haemorrhage. A 55-year-old female presented with right flank pain after a fall from a static pushbike. Computer tomography identified a large adrenal lesion with surrounding acute retroperitoneal haemorrhage. A conservative approach to treatment was decided on as the patient remained haemodynamically stable. The patient developed a pulmonary embolism during the time of conservative management and therefore had to be anticoagulated with close monitoring. Outpatient surveillance imaging was reassuring, hormonal screening was negative and biopsy confirmed myelolipoma. We report a rare presentation of adrenal myelolipoma with the sequelae of haemorrhage from low-impact trauma and the challenges of conservative management.