Acute Nonhemorrhagic Adrenal Infarction in Pregnancy: 10-Year MRI Incidence and Patient Outcomes at a Single Institution

Glomski, Sha-har A.; Guenette, Jeffrey P.; Landman, Wendy B.; Tatlı, Servet

doi:10.2214/ajr.17.18739

Cited by 30 publications

(44 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the absence of an obvious diagnosis with ultrasound, MRI is the next preferred modality due to its safety in pregnancy. MRI findings of non-haemorrhagic adrenal infarction have only recently been defined in a 10-year single institution study 6. These consist of increased T2 signal intensity of the infarcted adrenal with surrounding oedema and without T1 intensification to suggest lack of haemorrhage, as seen in our patient.…”

Section: Discussionsupporting

confidence: 50%

“…Although, one author recommends conservative management based on a single case report showing complete resolution of symptoms and uncomplicated perinatal outcome without anticoagulation 9. A more recent case series of four patients with five instances of adrenal infarctions showed that two patients who did not receive anticoagulation had uncomplicated perinatal outcome but the third patient who was discharged without anticoagulation in the 17th week of gestation presented back in her 35th week with contralateral adrenal infarction and was then anticoagulated for 6 months 6…”

Section: Discussionmentioning

confidence: 99%

“…Adrenal gland infarction is usually haemorrhagic and bilateral 1. Unilateral adrenal gland infarction in pregnancy is extremely rare, with eight cases reported in medical literature to date 2–6. Most of these infarcts were associated with an underlying thrombophilic syndrome, like antiphospholipid syndrome, Factor VIII abnormality4 or methylenetetrahydrofolatereductase gene mutation 2…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Agarwal¹,

Soe

2019

BMJ Case Rep

View full text Add to dashboard Cite

Adrenal infarction is a rare event, especially in pregnancy. The diagnosis is challenging because patients present with acute abdomen and initial workup are usually unrevealing. We present a case of unilateral adrenal infarction in a pregnant young woman without any other causes of thrombophilia, who presented with acute abdominal pain and an unremarkable initial workup. MRI and contrast-enhanced CT scan revealed a non-haemorrhagic infarct of the right adrenal gland. Our case highlights the importance of considering this rare diagnosis in the differential for a pregnant woman with acute abdomen without any obvious surgical cause.

show abstract

Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Agarwal¹,

Soe

2019

BMJ Case Rep

View full text Add to dashboard Cite

show abstract

“…Acute adrenal infarction (AAI) is a rare but serious complication of hypercoagulable conditions such as primary antiphospholipid antibody syndrome or pregnancy [4,5]. CT diagnosis of AAI is based on an enlargement and a low attenuation of the infarcted adrenal gland, sometimes associated with a high attenuation surrounding rim with fat stranding and "capsular sign" [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Acute adrenal infarction as an incidental CT finding and a potential prognosis factor in severe SARS-CoV-2 infection: a retrospective cohort analysis on 219 patients

et al. 2020

View full text Add to dashboard Cite

Objectives To retrospectively investigate the incidence of acute adrenal infarction (AAI) in patients who underwent chest CT for severe SARS-CoV-2 infection and to correlate findings with prognosis. Methods The local ethics committee approved this retrospective study and waived the need of informed consent. From March 9 to April 10, 2020, all patients referred to our institution for a clinical suspicion of COVID-19 with moderate to severe symptoms underwent a chest CT for triage. Patients with a/parenchymal lesion characteristics of COVID-19 involving at least 50% of lung parenchyma and b/positive RT-PCR for SARS-CoV-2 were retrospectively included. Adrenal glands were reviewed by two independent readers to look for AAI. Additional demographics and potential biological markers of adrenal insufficiency were obtained. Correlations with ICU stay and mortality were sought. Results Out of the 219 patients with critical (n = 52) and severe lung (n = 167) parenchyma lesions, 51 (23%) had CT scan signs of AAI, which was bilateral in 45 patients (88%). Four patients had an acute biological adrenal gland insufficiency (8%). Univariate analysis in AAI+ patients demonstrated a higher rate of ICU stay (67% vs. 45%, p < 0.05) and a longer stay (more than 15 days for 31% for AAI+ vs. 19%, p < 0.05) compared with AAI− patients. Mortality rate was similar (27%, p = 0.92). Conclusions Acute adrenal infarction on initial chest evaluation of severe COVID-19 is frequent (51/219, 23%) and might be a sign of poorer prognosis. Key Points • Acute adrenal infarction on initial chest CT evaluation of severe COVID-19 is frequent (51/219). • AAI might be a factor of poorer prognosis, with increased rate of ICU hospitalization and length of stay.

show abstract

“…It is logical that these two risk factors together, hypercoagulability of pregnancy and adrenal vein anatomy, may exacerbate blood stasis within the adrenal vein and lead to venous thrombosis. The risk of a thrombosis and consequentially infarction should be considered in non-pregnant patients with a known hyper-coagulable state [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Diffusion Weighted Imaging in Unilateral Adrenal Infarction: A Case of Colicky Right Upper Quadrant Pain in a Pregnant Female

Padilla¹,

Way²,

Soule³

et al. 2021

Cureus

View full text Add to dashboard Cite

Diffusion weighted imaging (DWI) is a magnetic resonance imaging (MRI) non-contrast sequence that can indicate tissue ischemia or infarction. Adrenal infarct may present similarly to biliary or gallbladder pathologies, and the differential diagnosis during emergency work-up can be narrowed utilizing DWI sequences. In this paper, we describe the usefulness of DWI for urgent diagnosis in a case of nonhemorrhagic adrenal infarct of a pregnant female presenting with right upper quadrant pain. Although uncommon, adrenal infarct may occur in patients with hypercoagulability and localizing pain that is unexplained by other imaging modalities. We outline the imaging features of DWI in evaluating adrenal infarct as a safe and time effective application for patients with contraindications to imaging with ionizing radiation.

show abstract

Acute Nonhemorrhagic Adrenal Infarction in Pregnancy: 10-Year MRI Incidence and Patient Outcomes at a Single Institution

Cited by 30 publications

References 40 publications

Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Cryptogenic adrenal infarction: a rare case of unilateral adrenal infarction in a pregnant woman

Acute adrenal infarction as an incidental CT finding and a potential prognosis factor in severe SARS-CoV-2 infection: a retrospective cohort analysis on 219 patients

Diffusion Weighted Imaging in Unilateral Adrenal Infarction: A Case of Colicky Right Upper Quadrant Pain in a Pregnant Female

Contact Info

Product

Resources

About