Acute unilateral nonhemorrhagic adrenal infarction

Case contributed by Dr Yair Glick

Presentation

Left flank pain.

Patient Data

Age: 16 years
Gender: Female

The kidneys are of normal size, with good nephrographic and pyelographic effect. No evidence of nephrolithiasis or dilation of the intrarenal or extrarenal collecting system on either side.

Small parapelvic cyst in the right kidney.

The left adrenal is thick in comparison to the right one, does not enhance on the post-contrast sequences, and is surrounded by fat stranding.

Before contrast material injection, both adrenals show the same soft tissue density.

During the nephrographic phase, the right adrenal enhances significantly, while the left adrenal does not enhance at all.

During the excretory phase, done 10 minutes after contrast material injection, contrast enhancement of the right adrenal has subsided but not entirely, and the left adrenal stays unenhanced.

Case Discussion

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).

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Case information

rID: 67560
Published: 7th May 2019
Last edited: 16th May 2019
Inclusion in quiz mode: Included
Institution: Laniado Hospital

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