We presented a case of huge adrenal myelolipoma in a patient admitted for a cerebrovascular accident with right hemiparesis. A huge fat-containing tumor depicted as hyperechoic retroperitoneal tumor mass was found hr screening abdominal sonography and confirmed by computed tomography (CT). The CT features of the hypoattenuating mass was consistent with fat tissues mixed with some soft tissue density representing myeloid tissue. Due to the large size of the tumor and the presence of hemorrhage elective surgical resection of the tumor was performed. The pathological diagnosis is adrenal myelolipoma since the tumor contained mature adipose tissue in combination with hematopoietic components. This report presents some typical sonographic and CT features of adrenal myelolipoma. The presence of hemorrhage and calcification within the tumor however, also contributed to the variable sonographic pattern and caused some difficulty in diagnosis.