Role of multidetector row computed tomography in the assessment of adrenal gland injuries

doi:10.1016/j.ejrad.2006.04.029

European Journal of Radiology

Volume 59, Issue 3, September 2006, Pages 355-358

https://doi.org/10.1016/j.ejrad.2006.04.029 Get rights and content

Abstract

Objective

To determine the prevalence of adrenal injuries in a group of patients submitted to multidetector row CT evaluation after blunt trauma and to assess the impact of CT findings on clinical management decisions.

Materials and method

During a 4-year period, 2026 emergency CT examinations were performed in the setting of major blunt trauma. A total of 82 patients were retrospectively identified as having adrenal gland traumatic lesions. At multidetector row CT the following findings were considered specific of adrenal injury: round or oval hematoma expanding the adrenal gland, irregular hemorrhage obliterating the gland, uniform adrenal gland swelling, active extravasation of contrast material from the adrenal vessels and adrenal gland rupture. Associated CT findings were: stranding of the periadrenal fat, diffuse hemorrhage in the adjacent retroperitoneum and compression of the adrenal gland by adjacent traumatic lesions.

Results

We identified 82 patients (46 males and 36 females, age ranging from 15 to 86 years) with adrenal injuries. The right adrenal gland was injured in 60/82 patients, while the left adrenal gland was injured in 21 cases; in 1 patient bilateral adrenal gland traumatic lesions occurred. In 76 patients with non-isolated adrenal injuries concomitant injuries to the liver (49 cases), ipsilateral kidney (18 cases) and spleen (9 cases) were observed. Round or oval hematoma expanding the adrenal gland (61 cases), irregular hemorrhage obliterating the gland (14 cases), stranding of the periadrenal fat (9 cases) and diffuse hemorrhage in the adjacent retroperitoneum (8 cases) were the more frequent findings detected at CT. Six patients underwent surgical intervention for the presence of major injuries to the spleen (three cases), to the liver (one), to the right kidney (one), to the left kidney (one). Seventy-six patients were conservatively treated.

Conclusion

Blunt adrenal injuries typically present as part of a multiorgan trauma. Familiarity with characteristic CT findings of adrenal trauma is essential for the radiologist to avoid misdiagnosis.

Introduction

Adrenal injury secondary to trauma is quite rare because of the position of the adrenal gland deep within the abdomen, well cushioned by surrounding soft tissue structures.

As reported in the literature [1], computed tomography (CT) plays a leading role in the evaluation of traumatic disease of the adrenal gland.

The main goals of this study are: (1) to determine the prevalence of adrenal injuries in a group of patients submitted to multidetector row CT evaluation after blunt trauma and (2) to assess the impact of CT findings on clinical management decisions.

Section snippets

Materials and methods

During a 4-year period, from March 2001 to March 2005, 2026 emergency CT examinations were performed in the setting of major blunt trauma. A total of 82 patients (46 males and 36 females, age ranging from 15 to 86 years) were retrospectively identified as having adrenal gland traumatic lesions.

CT examination was performed using a 16-slice scanner (Aquilion 16, Toshiba, Tokyo, Japan). This scanner is located at the −1 level, in the Section of Diagnostic Imaging of the Emergency Department of our

Results

Among 2026 trauma cases, we identified 82 patients (4%) with adrenal injuries. The causes of injury were car accident in 32 patients (39%), motorcycle accidents in 28 (34.14%), fall from height in 16 (19.52%), pedestrian injuries in 4 (4.9%) and work-place accident in the remaining 2 (2.44%).

Multidetector row CT study showed the presence of non-isolated traumatic lesions of the adrenal gland in 76/82 (92.7%); in the remaining six cases the adrenal traumatic lesions were isolated. The right

Discussion

Adrenal injury is noted in approximately 2–3% of blunt abdominal trauma cases [2], [3].

In a high percentage of cases, it is accompanied by other intra-abdominal, retroperitoneal, or intrathoracic injuries. The exact mechanism of traumatic adrenal injury is still unknown: adrenal glands are susceptible to massive intraglandular bleeding due to their complex vascular supply. Several mechanisms have been proposed. These include direct compression of the gland between the spine and liver by direct

Conclusions

Blunt adrenal injuries typically present as part of a multiorgan trauma. The right adrenal gland is more frequently injured, with liver trauma as the most commonly associated traumatic lesion.

Familiarity with characteristic CT findings of adrenal trauma is essential for the radiologist to avoid misdiagnosis. Awareness of this possibility and early diagnosis can impact on the triage and management of these patients.

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“Blunt adrenal injury does not affect outcomes in the pediatric population with isolated abdominal injury- a National Trauma Data Bank Review®.”
2024, American Journal of Surgery
The incidence of blunt abdominal injury (BAI) in the adult population has been estimated to be between 0.03% and 4.95%. However, the impact of BAI on the pediatric population remains unknown.
We conducted a retrospective review of National Trauma Data Bank datasets for the years 2017–2019. We included patients under the age of 18 who experienced blunt trauma and had suffered a blunt abdominal injury with an Abbreviated Injury Scale (AIS) severity score of 2 or higher.
Out of the 8064 pediatric patients with isolated abdominal trauma, 134 patients also suffered from BAI. We found no difference in the outcomes of patients with blunt adrenal injury in terms of mortality, length of stay in the intensive care unit (ICU) and hospital, and the number of ventilator days. Within poly-trauma patients BAI was associated with worst patient outcomes.
This study demonstrates that BAI has minimal clinical impact on patient outcomes in isolation. However it is associated with worst outcomes in poly trauma patients suggesting correlation with increased trauma burden.
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Adrenal myelolipoma is a benign tumor of the adrenal cortex composed predominantly of fat and hematopoietic tissue. These lesions are usually asymptomatic, and most often incidentally detected on imaging. Uncommonly, they present with retroperitoneal hemorrhage, and these have been traditionally treated with emergent surgery. Although, transarterial embolization has been effectively and safely used in patients presenting with active hemorrhage from acute traumatic and nontraumatic causes, literature specifically pertaining to adrenal artery embolization is scant, perhaps due to smaller size and variability of adrenal arteries. With recent advances in endovascular techniques and imaging, there are emerging case reports and series of adrenal artery embolization in acute and nonacute settings. We report a case of spontaneous hemorrhage within an adrenal myelolipoma in a 43-year-old male patient, successfully treated with transarterial embolization, thereby avoiding major surgery. Our report adds to the growing body of literature pertaining to adrenal artery embolization.
Management of blunt adrenal gland injury in a community-based hospital
2019, Injury
Injury of the adrenal gland in blunt trauma is rare. The routine usage of the whole body computed tomography (CT) scan helps in early diagnosis. We aimed to study the incidence, mechanism of injury, management, and outcome of adrenal injury in blunt trauma patients treated in a community-based hospital.
CT scan of the abdomen of all blunt trauma patients who were admitted to our institution between October 2010 and March 2018 were retrospectively reviewed. The files of all the patients with CT scan-detected adrenal injuries were retrieved. Studied variables included demography, mechanism of injury, associated injuries, GCS, ISS, Intensive Care Unit admission, hospital stay, and outcome.
4991 blunt trauma patients were admitted to the hospital. CT scan of the abdomen was performed for 2359 (47%) patients. Blunt adrenal injuries were diagnosed in eleven male patients (0.22%). The main mechanism of injury was motor vehicle collisions in eight (72.7%) patients. Nine (81.8%) patients had right adrenal gland injury. The mean (range) ISS was 22 (6–50). All patients had intra-adrenal hematoma and periadrenal fat stranding. None of our patients had acute adrenal insufficiency. One patient died (overall mortality 9.1%).
The incidence of blunt adrenal injury, although rare, is similar in a community-based hospital to those reported from trauma I centers. It is associated with severe and multiple organ injuries. Blunt adrenal injuries are usually self-limiting.
Imaging of Blunt Abdominal Solid Organ Trauma
2016, Seminars in Roentgenology
Citation Excerpt :
However, when adrenal injuries occur, they are more likely to be associated with major trauma and multiple other organ injuries.67-69 Most cases are unilateral and occur more often on the right.67-69 Although adrenal trauma can usually be treated nonoperatively, bilateral adrenal damage can cause adrenal insufficiency.67
Isolated adrenal hemorrhage after blunt trauma: Case report and literature review
2013, Urological Science
Citation Excerpt :
Adrenal gland injury is an uncommon consequence caused by blunt abdominal trauma, such as motor vehicle collisions, falls, or injuries in sports.1–3 The estimated incidence rate of the injury is approximately 2–3%.3,4 Isolated adrenal hemorrhage is a very rare subset of this type of injury and usually has limited clinical significance.5
Isolated adrenal hemorrhage following blunt abdominal trauma is rare. The wide variation in clinical manifestations and lack of specific biologic markers make its diagnosis difficult. Computed tomography (CT) remains the golden standard for detecting this injury. Although isolated adrenal hemorrhage is usually silent and self-limiting, the presence of adrenal hemorrhage in a patient with trauma is associated with higher injury severity, and coexisting injury to the liver, ribs, kidneys, or spleen is common. Blunt trauma-related acute thoracoabdominal pain and skeletal pain are common problems in the emergency room. Patients should be carefully evaluated according to their trauma mechanism and physical examination. If an unusual complaint is presented (e.g., pain associated with cold seating or pain persisting after general analgesics), the emergency room physician should be aware of adrenal injury, the possibility of associated organ injury, and the potential for adrenal insufficiency. It is also necessary for clinicians to become familiar with common diagnostic tools, treatment options, and trends for noninvasive procedures. Prompt recognition of associated injuries and the potential for mortality with adrenal insufficiency can provide the best guidance for patient treatment and care. In this article, we present the report of a 32-year-old male, who suffered from blunt chest trauma and complained of ill-defined chest pain associated with cold seating. His CT results revealed a left adrenal hemorrhage with a large retroperitoneal hematoma. The patient was treated successfully with conservative observation.
Isolated adrenal hematoma presenting as acute right upper quadrant pain
2012, Journal of Emergency Medicine
Background: Adrenal hematoma is an infrequent occurrence in the setting of adult trauma care. It is typically associated with diffuse abdominal injury, and its presence is commonly correlated with high injury severity and mortality. Objectives: To discuss the recognition of adrenal hematoma as a cause of right upper quadrant pain. Case Report: We present the case of a 23-year-old man who presented to the Emergency Department (ED) with acute right upper quadrant pain after blunt trauma to the area; he was initially diagnosed with an abdominal contusion with an incidental adrenal adenoma. After experiencing continued pain for 2 days, the patient returned to the ED for re-evaluation. Subsequent imaging revealed that the adrenal mass had enlarged, and it was determined that this patient had suffered an acute adrenal hematoma. The lesion was determined to be self-limited and the patient was treated with supportive care. Follow-up images 8 weeks later revealed resolution of the hematoma and the patient reported complete resolution of symptoms. We also discuss adrenal hematoma in the trauma setting and explain that in our patient, given the clinical scenario and statistical evidence, an initial diagnosis of adrenal hematoma should be favored over abdominal contusion with incidental adenoma. Conclusion: We describe a case of a traumatic isolated adrenal hematoma that presents acutely as right upper quadrant pain. This unusual presentation highlights the need for recognition of the adrenal gland as a potential cause of right upper quadrant pain in the trauma setting.

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Role of multidetector row computed tomography in the assessment of adrenal gland injuries

Abstract

Objective

Materials and method

Results

Conclusion

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Trauma

Radiol Clin North Am

Acute adrenal injury after blunt abdominal trauma: CT findings

AJR Am J Roentgenol

Posttraumatic adrenal hemorrhage in children: CT findings in 34 patients

AJR Am J Roentgenol

Imaging of adrenal hemorrhage

Radiologist