Adrenal hemorrhage and hemorrhagic masses; diagnostic workup and imaging findings

Abstract

Adrenal hemorrhage (AH) is a rare condition. It can be traumatic or non-traumatic. Most common causes are septicemia, coagulopathy or bleeding diathesis, and underlying neoplasms. Other reported less common causes of AH are COVID-19 and neonatal stress. Clinical diagnosis of AH is challenging due to its non-specific presentation and occurrence in the setting of acute medical illness. Therefore, most cases are diagnosed incidentally on imaging. Having high clinical suspicion in the proper clinical setting for AH is crucial to avoid life-threatening adrenal insufficiency that occurs in 16–50% of patients with bilateral AH. We discuss the clinical situations that predispose to AH, review the imaging features on different imaging modalities, highlight a variety of clinical cases, imaging features that should be concerning for an underlying neoplasm, and outline the potential role of interventional radiology in management of AH.

Transradial Embolization of Hemorrhagic Adrenal Myelolipoma

“…4 In patients who do require intervention, transcatheter arterial embolization is a proven method for treatment and we demonstrate its use in the management of acute hemorrhage in a patient who was not an ideal surgical candidate due to several comorbidities. 1,5 Moreover, this case highlights the use of minimally invasive techniques in patients with complex medical histories that require urgent hemostasis. Further, we present the use of radial artery access for embolization of acute hemorrhage to achieve fewer complications and faster recovery times.…”

“…1 Although most do not require treatment, tumors with rapid growth may be predisposed to acute hemorrhage, and others may require treatment for suppression of endocrine function or for size reduction. 1,4 Clinical decision-making during monitoring of these tumors should focus on these factors, and particularly tumor size, when considering the risk for spontaneous hemorrhage. For example, in a case report of 75 patients with diagnosed ML, the incidence of hemorrhage was associated with larger masses (14.4 cm vs. 10.4 cm).…”

“…Myelolipomas are benign, mostly non-functioning, and asymptomatic incidentalomas. 1 Although most do not require treatment, tumors with rapid growth may be predisposed to acute hemorrhage, and others may require treatment for suppression of endocrine function or for size reduction. 1,4 Clinical decision-making during monitoring of these tumors should focus on these factors, and particularly tumor size, when considering the risk for spontaneous hemorrhage.…”

Diagnóstico prenatal de neuroblastoma quístico suprarrenal fetal

“…Las imágenes de resonancia magnética fetal es un complemento de la ecografía prenatal y su principal ventaja es su capacidad para obtener imágenes en cualquier plano, especialmente en los casos en que los hallazgos ecográficos son inespecíficos debido a la obesidad materna u oligohidramnios. También permite confirmar la localización anatómica y excluir la hemorragia suprarrenal o quistes corticales renales (10,16) . Las imágenes T2 ponderadas muestran señales marcadas en la composición quística y moderada en la composición sólida.…”

“…Las imágenes T2 ponderadas muestran señales marcadas en la composición quística y moderada en la composición sólida. Las áreas de hemorragia intratumoral suelen tener alta intensidad de señal en las imágenes T1 (16) . La gammagrafía con metayodobencilguanidina, marcador específico del tejido tumoral simpático, proporciona un método eficaz para detectar neuroblastomas quísticos neonatales, con una sensibilidad del 70% (15,17) .…”