Adrenal hemorrhage secondary to blunt trauma

   January 15, 2021  Posted in Abdomen, Trauma

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 30 years old man, no known medical illness
  • Was trying to break into a double-storey house
  • Had a fall while trying to run away from police
  • On arrival at ED, patient was conscious, complaint of abdominal and back pain
  • Vital signs are stable
CT scan of abdomen and pelvis in axial plane soft tissue window post contrast

 

CT scan abdomen and pelvis in axial plane bone window

 

CT scan at lower thorax in axial plane lung windows post contrast

 

Reformatted CT scan of abdomen in coronal and saggittal plane soft tissue window post contrast

 

CT scan at the level of right adrenal in axial plane soft tissue window pre and post contrast that shows the right adrenal hemorrhage as hyperdense on post contrast and relatively hypodense on post contrast image.

CT scan findings:

  • Right adrenal haematoma
  • Tranverse process fractures of right lumbar spine with psoas haematoma
  • Right renal injury grade 2
  • Pneumothorax and lung contusion
  • Fracture of sacrum on the left side

Progress of patient

  • Patient was managed conservatively
  • Discharged well

Diagnosis: Right adrenal hemorrhage with other multiple injuries

Discussion:

  • Adrenal gland trauma is present on 1-2% of CT imaging in blunt trauma
  • Isolated adrenal gland trauma is uncommon <5% of all adrenal trauma
  • As demonstrated in this case, it is commonly associated with other injuries
  • CT findings include a well-defined nodular mass, within either the body or the limb with a density of 50-80 HU, diffuse enlargement or replacement of the adrenal gland with less well-defined borders  and periadrenal fat stranding.
Author: radhianahassan