Blunt liver and adrenal injuries

Case contribution: Dr Radhiana Hassan


  • A 21 years old man
  • Involved in MVA; motorcyclist hit by a car
  • On arrival vital signs were stable and patient was fully conscious
  • Patient complaint of right abdominal pain.
Contrast enhanced CT abdomen in axial plane, soft tissue window
CT scan at right adrenal level in axial plane, plain and post contrast soft tissue window
CT scan at thoracic level axial plane in lung window

CT scan findings:

  • Multiple short lacerations within the liver in the right lobe (red arrows)
  • Right adrenal gland is diffusely enlarged with streakiness of surrounding fat and indinstinct border or outline (yellow arrow)
  • Associated minimal fluid at hepatorenal fossa
  • No other organ injury
  • Also noted to have right pneumothorax (white arrow) and multiple contusions (blue arrows)
  • No rib fracture is seen.

Progress of patient:

  • Patient was managed conservatively
  • Discharged well few days after.

Diagnosis: Grade II liver injury with right adrenal injury


  • Adrenal gland trauma is present on 1-2% of CT imaging in blunt trauma.
  • The right adrenal gland is more commonly affected than the left.
  • Isolated adrenal gland trauma is uncommon;<5% of all adrenal trauma.
  • Associated injuries include lung injuries, liver, spleen and/or renal injuries, rib, pelvic or spine injuries and head injury
  • CT appearance include mass-like hematoma, diffuse enlargement of the gland, splaying of adrenal limbs and surrounding fat stranding


Author: radhianahassan