Thickened, nonenhancing left adrenal with surrounding fat stranding, compatible with acute adrenal infarction and providing an explanation for the patient's left flank pain.
Parental questioning revealed that the girl had had several episodes of dural venous sinus thrombosis in her past. She went on to have blood tests and urinalysis for hypercoagulability.
Nonhemorrhagic unilateral adrenal infarction has been described almost invariably in pregnant women. Some of these women are found to have a congenital hypercoagulable state. The presenting symptom is flank or abdominal pain 1. In this extremely rare case, however, the incident occured in a 16-year-old girl who was not pregnant (normal beta hCG levels).