• Huizhen Xin, Haijun Li, Honghui Yu, Juan Zhang, Weizhi Peng, and Dechang Peng.
• Department of Radiology, The First Affiliated Hospital, Nanchang University, Jiangxi Province, The People's Republic of China.
• Medicine (Baltimore). 2019 Jul 1; 98 (29): e16497.

RationalePrimary hepatic myelolipoma is a rare benign neoplasm comprising mature adipose tissue and marrow components in various proportions. Chemical shift imaging (CSI) can distinguish the lipid within the tumor clearly; however, there have been no reports on the CSI of hepatic myelolipoma.Patient ConcernA 20-year-old woman visited our hospital after discovering a space-occupying lesion in the liver with a history of more than 1 year. She felt distension pain and discomfort under the xiphoid process, accompanied by nausea, vomiting, and occasional chest oppression.DiagnosisThe tumor showed a well-defined mass with a pseudocapsule and a heterogeneous appearance on both T1- and T2-weighted magnetic resonance (MR) images. CSI analysis showed a signal decline within the tumor. Based on the histopathology, the tumor was diagnosed as hepatic myelolipoma.Interventions And OutcomesThe patient underwent a right hepatectomy, and the postoperative vital signs were stable. Two weeks later, the patient was discharged safely.LessonsAlthough hepatic myelolipoma is extremely rare, this condition should be considered in differential diagnosis when CSI shows that hepatic lesions contain fatty.

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