A Case of Traumatic Bilateral Adrenal Hemorrhage Mimicking Bilateral Adrenal Adenomas

Abstract

Adrenal hemorrhages caused by blunt abdominal trauma have been frequently reported, and most of the lesions are unilateral. In contrast, bilateral hemorrhage of the adrenal glands after trauma rarely occurs in subjects with predisposing conditions such as coagulopathy, thromboembolism, and sepsis. Furthermore, bilateral hemorrhage of the adrenal glands is potentially fatal by inducing acute adrenal insufficiency. Here,a case of a 40-year-old man who developed traumatic bilateral adrenal hemorrhage after a car accident, without any predisposing condition, is reported. The spontaneous shrinkage of the bilateral lesions revealed in the follow-up abdominal computed tomography (CT) scansupported the aforementioned diagnosis. Fortunately, the patient had no clinical or biochemical evidence suggesting acute adrenal insufficiency. To these authors' knowledge, this is the first South Korean report of traumatic bilateral adrenal hemorrhage in a subject with no predisposing factors.

Imaging of unilateral adrenal hemorrhages in patients after blunt abdominal trauma: Report of two cases

“…The right adrenal vein directly enters the inferior vena cava, but the left adrenal vein drains into the left renal vein or inferior phrenic vein. Therefore, severe compression of the inferior vena cava might be responsible for intraglandular hemorrhage due to increased adrenal venous pressure 5 . In the present case report, there was a history of falls from heights with multiple bone fractures and unilateral adrenal hemorrhage without intra-abdominal solid organ injury.…”

“…The administration of fludrocortisone is recommended for mineralocorticoid supplementation. Delayed replacement or misdiagnosis can be fatal for patients 5 . According to the literature, 16%–50% of patients with bilateral adrenal hemorrhage have been reported to have life-threatening adrenal insufficiency 7 .…”

Adrenal hematoma following falling in a 5-year-old boy

“…While bilateral adrenal hemorrhage is not a common condition, it has detrimental effects on patients’ life in adults and may cause adrenal insufficiency, which can be deleterious. 4 …”

Multi-detector computed tomography in the diagnosis and characterization of adrenal gland traumatic injuries

“…Some cases of adrenal rupture have also been reported (24). Delays in diagnosis or misdiagnosis are often fatal for patients (33). In between 20% and 50% of the patients, the patients with bilateral adrenal hemorrhage had presented life-threatening adrenal insufficiency.…”

“…If the hematoma does not completely reabsorb and persists, an organized, chronic hematoma appears as a mass with a low-density center, with or without calcifications. Such masses are termed ''adrenal pseudocysts'' (33). The presence of calcifications can affect enhancing components on postcontrast CT.…”