Bilateral adrenal vein thrombosis

Case contributed by Fabien Ho
Diagnosis almost certain


27 weeks' gravida. Past history of 3 spontaneous abortions. Acute abdominal epigastric pain radiating to back, no fever, normal urinalysis strips, normal lipase on blood sampling. WBC 20 G/L, CRP 100. Hypothesis of ovarian vein thrombosis.

Patient Data

Age: 30 years
Gender: Female

Bilateral adrenal gland edema and enlargement on portal venous phase CT scan.

Oriented MRI after CT results


Both T1w fast gradient echo and T2-FSw sequences showed material within the IVC lumen suspicious for partial thrombosis.

Oriented US scan after MRI


US showed the same material within the retrohepatic IVC, consistent with partial thrombosis.

Case Discussion

Bilateral adrenal gland enlargement in the setting of acute pain in pregnancy is consistent with either hemorrhage or thrombosis.
In this case, pregnancy did not allow multiphased CT; hence, non-contrast CT was not performed.

However, several clinical and imaging clues facilitated the confident diagnosis of bilateral adrenal thrombosis:

  • a past history of 3 miscarriages suspicious for an underlying thrombophilic disease, associated with current pregnancy at 27WG.
  • adrenals density was 20HU on average after contrast media administration.
  • partial thrombi in the IVC, one closely related to the anatomical junction with the right adrenal gland.

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