Traumatic adrenal hemorrhage


  • A 17 years old boy
  • Alleged MVA
  • On arrival in ED, GCS 15/15, vital signs are stable
CT scan abdomen in axial planes soft tissue window

CT scan findings:

  • An oval-shaped lesion at right adrenal region which is hyperdense on pre-contrast image
  • Post contrast image shows the lesion to be relatively hypodense than the surrounding normal enhancement of right adrenal gland
  • There is associated streakiness of the fat plane surrounding the right adrenal gland.
  • This is in keeping with right adrenal hemorrhage.

Diagnosis: Traumatic right adrenal hemorrhage.


  • Adrenal gland trauma is present on 1-2% of CT imaging in blunt trauma.
  • Adrenal hemorrhage is the most common injury to the adrenal gland. Adrenal laceration is rare.
  • Isolated adrenal trauma is uncommon, comprising <5% of cases.
  • Associated injuries in adrenal gland trauma include lung injury, pneumothorax, solid abdominal organ injuries, ribs and spine fractures and head injuries.
  • On ultrasound, an early-stage haematoma appears as solid with diffuse or inhomogeneous echogenicity.
  • On CT scan, adrenal hematomas appear round or oval, often with surrounding stranding of the periadrenal fat.
  • Adrenal hematomas decrease in size and attenuation over time, and most resolve completely

Progress of patients:

  • Patient was treated conservatively
  • He also sustained other injuries:

Other CT findings in this case:

  • A: Bone window shows fracture of transverse process of lumbar vertebra
  • B: Lung window shows right pneumothorax with lung contusion
  • C: Pre contrast CT abdomen shows hyperdense collection surrounding the right renal suggestive of perinephric hematoma.
  • D: Post contrast CT abdomen shows right renal laceration through the cortex not extending to the collecting system and not causing urinary extravasation in keeping with Grade III renal injury.
Author: radhianahassan