Myelolipomas are rare benign neoplasms of the adrenal glands, characterized by the presence of adipose tissue and elements of bone marrow in various degrees of differentiation. Usually asymptomatic, they are discovered incidentally or at autopsy; sometimes larger masses may cause local symptoms. We report clinical, radiologic and therapeutic aspects of a large myelolipoma of the right adrenal gland, presenting with unusual epigastric symptoms.