A 72-year-old man presented with a mediastinal mass on chest radiograph. Co
mputed tomography and MR imaging showed that the mass consisted of both fat
ty and small nodular soft tissue components, highly suggestive of an extram
edullary hematopoiesis or a myelolipoma. A CT-guided needle biopsy was next
performed and confirmed the diagnosis. We discuss the CT and MR imaging ap
pearances of this tumor and usefulness of a CT-guided needle biopsy to avoi
d surgery in asymptomatic patients.