- “ 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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