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Adrenal: Adrenal Hematoma Imaging Pearls - Learning Modules | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Adrenal ❯ Adrenal Hematoma

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  • “Posttraumatic adrenal hemorrhage is usually unilateral, although bilateral involvement can occur . While uncommon overall, nontraumatic adrenal hemorrhage is typically bilateral and can be caused by a wide range of conditions, with the most common being stress, hemorrhagic diathesis or coagulopathy, or an underlying adrenal mass . One series of 2000 consecutive autopsies performed over an 8-year period yielded an overall prevalence of 1.8% for bilateral adrenal hemorrhage in a nontrauma setting.”


    From the Radiologic Pathology Archives: Adrenal Tumors and Tumor-like Conditions in the Adult: Radiologic-Pathologic Correlation
Grant E. Lattin, Jr et al.
RadioGraphics 2014 34:3, 805-829 
  • “Common stress events include severe burns, sepsis, surgery, or hypotension. Anticoagulant therapy can cause spontaneous adrenal hemorrhage. Causes of adrenal vein thrombosis, including hypercoagulable states, can cause hemorrhagic infarction of the gland. ACAs, myelolipomas, pheochromocytomas, metastases, and ACC are some of the adrenal masses known to cause spontaneous adrenal hemorrhage, therefore careful inspection is required at imaging to exclude such lesions when adrenal hemorrhage is identified.”

    
From the Radiologic Pathology Archives: Adrenal Tumors and Tumor-like Conditions in the Adult: Radiologic-Pathologic Correlation
Grant E. Lattin, Jr et al.
RadioGraphics 2014 34:3, 805-829 
  • “In the setting of nontraumatic hemorrhage, the primary differential diagnostic considerations are an underlying mass that has spontaneously bled, including, as noted earlier, ACA, pheochromocytoma, myelolipoma, and a hypervascular metastasis. Identifying a small mass that has caused the bleeding can be challenging, especially at initial presentation. Clinical history, such as symptoms of adrenergic overactivity in the setting of pheochromocytoma, can help narrow the differential diagnosis. Identifying macroscopic fat can strongly suggest an underlying myelolipoma. Serial imaging can be helpful to assess for the evolution of a hematoma, as described earlier.”


    From the Radiologic Pathology Archives: Adrenal Tumors and Tumor-like Conditions in the Adult: Radiologic-Pathologic Correlation
Grant E. Lattin, Jr et al.
RadioGraphics 2014 34:3, 805-829 
  • “ The most common imaging features include a 2-3 cm oval hematoma, irregular hemorrhage obliterating the adrenal gland, periadrenal hemorrhage or fat stranding, and uniform adrenal swelling with increased attenuation.”
    Imaging of traumatic adrenal injury
    To’o KJ, Duddalwar VA
    Emerg Radiol (2012) 19:499-503
  • “ Traumatic adrenal injury occurs in 5% of cases of blunt abdominal trauma and most commonly affects the right adrenal gland only. While rare, adrenal injury is an indicator of severe trauma and should prompt a search for associated injuries. The most common imaging feature of adrenal injury is a 2-3cm oval hematoma.”
    Imaging of traumatic adrenal injury
    To’o KJ, Duddalwar VA
    Emerg Radiol (2012) 19:499-503
  • Adrenal Trauma: CT Findings
    - Adrenal hematoma (oval or round)
    - Irregular hemorrhage obliterating the gland
    - Uniform adrenal gland swelling with increased attenuation
    - Periadrenal hemorrhage or stranding
    - Retroperitoneal hemorrhage
    - Adrenal pseudocyst (chronic)
    - Imaging of traumatic adrenal injury
    To’o KJ, Duddalwar VA
    Emerg Radiol (2012) 19:499-503
  • Adrenal Masses
    - Adenoma
    - Myelolipoma
    - Metastases
    - Pheochromocytoma
    - Adrenal Cortical Carcinoma
    - Lymphoma
  • Adenoma with Hemorrhage
    - Rarely an adenoma can hemorrhage
    - Usually anticoagulated patient
    - Heterogeneous
    - Regions of high attenuation
  • “ Adrenal hemorrhage is rarely suspected clinically, exhibits no specific clinical symptoms or laboratory findings, and yet is immediately life threatening when bilateral. Recognition of adrenal hematomas is complicated by the variable appearance of these lesions.”
    CT of the Adrenal Gland: the many faces of adrenal hemorrhage
    Sacerdote MG, Johnson PJ, Fishman EK
    Emerg Radiol 2011 Oct 30 (epud ahead of print)
  • Adrenal Hemorrhage
    - Relatively uncommon, but potentially life threatening
    - Neonates > children > adults: Most common cause of adrenal mass in infancy
    - Usually occurs within first week of life
    - Incidence 1.7- 3% per 1000 births
    - Neonatal gland is relatively hypervascular and weighs more than the adult gland
    - Unilateral or bilateral
  • Traumatic Hemorrhage
    - Blunt abdominal trauma
    - Unilateral in 80% of cases - Right 85%, Left 15%
    - Bilateral in 20% of cases
  • Nontraumatic Hemorrhage
    - Stress
    - Bleeding diathesis, coagulopathy
    - Adrenal tumors
    - Idiopathic
  • Adrenal Hemorrhage
    -Bilateral adrenal hemorrhage in 15% of patients who die of shock
    - Adrenal insufficiency occurs when 90% of adrenal tissue is destroyed
    - Stress or adrenal tumor --- increased ACTH --- increased arterial blood flow and limited venous drainage ---- adrenal hemorrhage
  • Adrenal Hemorrhage: CT Findings: Acute
    - Round or oval mass of high attenuation (50-90 HU)
    - Asymmetric enlargement
    - +/- associated adrenal or renal vein thrombosis
    - Homogeneous and no enhancement with contrast
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