Myelolipoma is a benign tumor of the adrenal region. However, it may exist in other regions such as presacral space, gastric, hepatic region, retroperitoneum, nasal cavity, testis, and even in thyroid. Case Presentation: We present a 55-years old male who was presented to the emergency department complaining of left lower abdominal pain and diarrhea. Physical examination and echocardiogram were normal. Radiological examination, including non-contrast and contrast CT, MRI, and PET, showed the

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... sence of right paraspinal lobulated soft tissue mass. This finding confirmed the diagnosis of myelolipoma The patient was treated with video-assisted thoracic surgery (VATS), and the mass was examined microscopically and by immunohistochemistry. Conclusion: Myelolipoma must be considered in the differential diagnosis of mediastinal tumors, it is rare, but it is possible to occur. Differential diagnosis of myelolipoma especially from extramedullary hematopoiesis is necessary. VATS is a feasible and safe treatment option for mediastinal myelolipoma.