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 hemorrhage 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 hemothorax
- liver, spleen and/or renal laceration
- rib, pelvic or spinal fractures
- head injury
Adrenal gland traumatic hemorrhage may also present with 1:
- posterior pararenal space hemorrhage
- IVC compression
- psoas muscle hematoma
- thickening of the diaphragmatic crus
- hematoma presents as a well-defined nodular mass, within either the body or the limb with a density of 50-80 HU 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
- periadrenal fat stranding is often present 1
- T1: hematoma is isointense to muscle, liver, renal cortex
- T2: hematoma is very hyperintense; hyperintense fat stranding 3
Treatment and prognosis
Adrenal gland trauma is important to recognize as mortality is twice as high in blunt trauma patients with adrenal gland injury than without 2. Management is often conservative but may vary depending on hemodynamic stability and the presence of active bleeding 6.
Complications include 1,4:
- acute adrenal insufficiency (if bilateral)
- delayed hemorrhage
- pseudocyst formation
- thrombus from IVC compression (rare)
Differentials to consider include:
- pre-existing adrenal mass
- hemorrhage into the existing adrenal tumor
- 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 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
- 6. Liao CH, Ouyang CH, Fu CY, Wang SY, Lin KJ, Kuo IM, Hsu CP, Yang SJ, Yuan KC, Hsu YP. The current status and management of blunt adrenal gland trauma. (2015) Surgery. 157 (2): 338-43. doi:10.1016/j.surg.2014.09.001 - Pubmed