Acute spontaneous unilateral adrenal hemorrhage: etiology and imaging findings in six cases

Abstract

Objective: To evaluate the computed tomography characteristics of patients admitted with clinical suspicion of acute adrenal hemorrhage at three centers over a 3-year period and in whom that diagnosis was ultimately confirmed. Materials and Methods: This was a retrospective analysis of computed tomography findings in patients with suspected acute adrenal hemorrhage. We included only those cases in which the diagnosis was confirmed. Patients with aortic rupture and retroperitoneal hemorrhage were excluded. The images were analyzed by an experienced radiologist and by two radiology residents. Results: Six cases of unilateral adrenal hemorrhage (three on the left and three on the right) were analyzed. On computed tomography, each appeared as a rounded, oval mass altering the usual anatomy of the adrenal gland. The maximum diameter was 12.2 cm, and attenuation ranged from 45 to 70 HU. There was no appreciable contrast enhancement. No calcifications were observed. Conclusion: Adrenal hemorrhage, albeit rare, is potentially fatal. Early diagnosis is essential. Therefore, recognition of the possible presentations of these lesions by radiologists may help prevent hemorrhage from progressing to adrenal insufficiency and death.

Case Report: Adrenal Pathology Findings in Severe COVID-19: An Autopsy Study

“…Of 78 patients with adrenal necrosis, 41% had thrombosis of the main adrenal vein and the capsular veins. 17 Venous thrombosis can occur in most of the cases in patients with severe infection, especially in the respiratory tract, 18 and bacterial infections. 19 Unilateral adrenal hemorrhage and necrosis, features identified in most of the reported patients, may result from direct damage to the adrenal or blood supply.…”

Presumptive nontraumatic adrenal hemorrhage preceding hypoadrenocorticism in a dog

“…10 Approximately 50% of human patients with bilateral adrenal hemorrhage eventually develop HOAC. 11 In our case, because the dog did not have any other known cause of HOAC (e.g. primary or secondary hypoadrenocorticism, prolonged corticosteroid use), stress-induced catecholamine release after systemic inflammation and surgery of the abdominal mass were suspected to have caused HOAC secondary to NTAH.…”

“…Because adrenal hemorrhage can cause compression and destruction of all 3 layers of the adrenal glands, resulting in the deficiency of adrenal hormones, it can cause acute HOAC 10 . Approximately 50% of human patients with bilateral adrenal hemorrhage eventually develop HOAC 11 . In our case, because the dog did not have any other known cause of HOAC (e.g.…”

“…Computed tomography shows diffuse thickening of the adrenal glands bilaterally with periadrenal fat stranding within adrenal hemorrhage 3,16 . Increased hydrostatic pressure within the adrenal capillary sinusoids causes diffuse adrenal gland enlargement, and fluid or bleeding extravasation leads to periadrenal stranding 3,11,16 . Another possible explanation for the adrenal gland thickening is congestion followed by hemorrhage 3 .…”

“…3,16 Increased hydrostatic pressure within the adrenal capillary sinusoids causes diffuse adrenal gland enlargement, and fluid or bleeding extravasation leads to periadrenal stranding. 3,11,16 Another possible explanation for the adrenal gland thickening is congestion followed by hemorrhage. 3 Adrenal hematoma appears as a round or oval lesion with duration-dependent variable attenuation values.…”