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

Associations

Isolated adrenal gland trauma is uncommon (<5% of all adrenal trauma 4) and associated injuries include 1-2:

Adrenal gland traumatic haemorrhage may also present with 1

CT
  • 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
MRI
  • T1: haematoma is isointense to muscle, liver, renal cortex
  • T2: haematoma is very hyperintense; hyperintense fat stranding 3

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
  • calcification
  • pseudocyst formation
  • thrombus from IVC compression (rare)

Differentials to consider include:

The presence of a discrete adrenal mass in the context of blunt trauma without injury to other abdominal organs or CT features of injury warrants follow-up investigation 1,4.

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Article information

rID: 26351
Systems: Urogenital, Trauma
Synonyms or Alternate Spellings:
  • Adrenal trauma
  • Adrenal injury
  • Adrenal gland injury
  • Adrenal laceration
  • Adrenal gland laceration
  • Traumatic adrenal injury
  • Traumatic adrenal gland injury

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Cases and figures

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    Case 1: right haematoma
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    Case 2: haematoma on right
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    Case 3: diffuse enlargement on left
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    Enlarged right ad...
    Case 4: enlarged right gland along with liver contusion
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    Case 5
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    Case 6: right-sided with grade V liver laceration
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    Case 7: right haematoma
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