Hypertensive adrenal hemorrhage

There is hemorrhage centered in the retroperitoneum on the left along Gerota's fascia and the anterior pararenal space with two focal globular masses measuring about 30 and 35 mm in diameter in the expected region of the left adrenal gland. There is no calcification within the lesions. There is more diffuse hematoma surrounding the left perirenal space superiorly.

There is a small focal arterial blush of contrast within the more medial mass which appears to be supplied by the left middle adrenal artery arising directly from the aorta. There is pooling within this lesion on the portal venous phase and it is largely resolved on the delayed acquisition.

Calcific coronary arteries. No arterial calcification of the aorta and major branches. The aorta has normal caliber throughout its length. There is normal three-vessel takeoff from the arch. The common hepatic artery arises directly from the aorta (normal variant). Bilateral accessory renal arteries with the small accessory artery on the right supplying the upper hilum and larger aberrant artery on on the left supplying the inferior pole. There is no evidence of arterial dissection, thrombus or aneurysm.

Minor atelectasis at the left lung base. No pleural effusion or pneumothorax. No pericardial effusion. No lymphadenopathy.

Exophytic cyst arising from the superior pole of the right kidney and small renal cortical cyst in the mid right kidney. The liver, gallbladder, spleen, right adrenal enhance normally. The urinary bladder is unremarkable. There is good renal excretion of contrast bilaterally on the delayed phase.

The small and large bowel have normal caliber and configuration. There is mild diverticulosis of the distal colon without diverticulitis. There is no intra-abdominal free gas or discrete collection.

Degenerative changes in the lumbosacral spine and sacroiliac joints.

Impression

Moderately large retroperitoneal hemorrhage centered in the region of the left adrenal gland demonstrating an active arterial blush from the middle left adrenal artery. Two rounded soft tissue foci in the expected region of the adrenal gland may represent hematoma or underlying adrenal lesions. In the setting of severe hypertension, pheochromocytoma is a consideration.

There is no evidence of aortic dissection.

Successful embolization of spontaneous hemorrhage and pseudoaneurysm of the left middle adrenal artery.