Adrenal gland trauma
Adrenal gland trauma most commonly results from blunt force trauma.
Adrenal gland trauma is present on 1-2% of CT imaging in blunt trauma although the occurrence is thought to be much higher as injury has been demonstrated at 28% in one autopsy series 1-4.
The right adrenal gland is more commonly affected than the left with a ratio of 3-4:1 2.
Adrenal haemorrhage is the most common injury to the adrenal gland and is thought to be a result of direct compression or increased venous pressures from IVC compression. Laceration of the adrenal gland is less common 2-3.
Isolated adrenal gland trauma is uncommon (<5% of all adrenal trauma 4) and associated injuries include 1-2:
- pulmonary contusions, pneumothorax and/or haemothorax
- liver, spleen and/or renal laceration
- rib, pelvic or spinal fractures
- head injury
Adrenal gland traumatic haemorrhage may also present with 1:
- posterior pararenal space haemorrhage
- IVC compression
- psoas muscle haematoma
- thickening of the diaphragmatic crus
- haematoma presents as a well-defined nodular mass, within either the body or the limb with a density of 50-80HU 1-2
- diffuse enlargement or replacement of the adrenal gland with less well-defined borders can also be seen and most often relates to laceration 1-2
- peri-adrenal fat stranding is often present 1
- T1: haematoma is isointense to muscle, liver, renal cortex
- T2: haematoma is very hyperintense; hyperintense fat stranding 3
Treatment and prognosis
Adrenal gland trauma is important to recognise as mortality is twice as high in blunt trauma patients with adrenal gland injury than without 2. Complications include 1,4:
- acute adrenal insufficiency (if bilateral)
- delayed haemorrhage
- pseudocyst formation
- thrombus from IVC compression (rare)
Differentials to consider include:
- pre-existing adrenal mass
- haemorrhage into existing adrenal tumour
- adrenal gland hyperenhancement: usually bilateral with preserved adrenal gland morphology and in the setting of hypotension
The presence of a discrete adrenal mass in the context of blunt trauma and without injury to other abdominal organs or CT features of injury warrants follow-up investigation 1,4.
- 1. Burks DW, Mirvis SE, Shanmuganathan K. Acute adrenal injury after blunt abdominal trauma: CT findings. AJR Am J Roentgenol. 1992;158 (3): 503-7. doi:10.2214/ajr.158.3.1738984 - Pubmed citation
- 2. Adrenal Imaging (Contemporary Medical Imaging). Humana Press. ISBN:B00A9YG23G. Read it at Google Books - Find it at Amazon
- 3. Murphy BJ, Casillas J, Yrizarry JM. Traumatic adrenal hemorrhage: radiologic findings. Radiology. 1988;169 (3): 701-3. Pubmed citation
- 4. Emergency Radiology. Elsevier Health Sciences. (2009) ISBN:0323076696. Read it at Google Books - Find it at Amazon
- 5. Venkatanarasimha N, Roobottom C. Intense adrenal enhancement: a feature of hypoperfusion complex. AJR Am J Roentgenol. 2010;195 (1): W82. doi:10.2214/AJR.09.3829 - Pubmed citation