Advertisement

Emergency Radiology

, Volume 19, Issue 6, pp 499–503 | Cite as

Imaging of traumatic adrenal injury

  • Katherine J. To’oEmail author
  • Vinay A. Duddalwar
Review Article

Abstract

Traumatic adrenal injury is a relatively rare event, reported in 0.15 to 4 % of blunt abdominal trauma cases. The location of the adrenal glands, protected deeply within the retroperitoneum, accounts for the rarity of adrenal trauma. These injuries are unilateral in 75 to 90 % of cases and most commonly afflict the right adrenal gland. While no specific clinical symptoms or signs point directly to adrenal injury, and isolated adrenal injury is rare, the presence of adrenal injury can be an indicator of severe trauma. In fact, mortality rates in series of adrenal injuries range from 7 to 32 %. The most common associated injuries affect the liver, ribs, kidney, or spleen. Three theories of adrenal injury from blunt trauma have been proposed: (1) acute rise in intra-adrenal venous pressure due to compression of the IVC during impact, (2) crushing between the spine and surrounding organs, and (3) deceleration forces shearing the small adrenal arterioles. The most common imaging features include a 2–3-cm oval hematoma, irregular hemorrhage obliterating the adrenal gland, periadrenal hemorrhage or fat stranding, and uniform adrenal swelling with increased attenuation. The differential diagnosis of adrenal abnormalities on trauma CT includes adenoma, carcinoma, myelolipoma, metastases, pheochromocytoma, and tuberculosis. Preexisting adrenal disorders can predispose the adrenal to injury with minor trauma. Most adrenal traumatic injuries are managed conservatively.

Keywords

Adrenal glands Trauma Computed tomography Soft tissue injury Hemorrhage 

References

  1. 1.
    Ramchandani P, Buckler PM (2009) Imaging of genitourinary trauma. AJR Am J Roentgenol 192(6):1514–1523. doi: 10.2214/AJR.09.2470 PubMedCrossRefGoogle Scholar
  2. 2.
    Roberts JL (1996) CT of abdominal and pelvic trauma. Semin Ultrasound CT MR 17(2):142–169PubMedCrossRefGoogle Scholar
  3. 3.
    Sinelnikov AO, Abujudeh HH, Chan D, Novelline RA (2007) CT manifestations of adrenal trauma: experience with 73 cases. Emerg Radiol 13(6):313–318. doi: 10.1007/s10140-006-0563-z PubMedCrossRefGoogle Scholar
  4. 4.
    Gomez RG, McAninch JW, Carroll PR (1993) Adrenal gland trauma: diagnosis and management. J Trauma 35(6):870–874PubMedCrossRefGoogle Scholar
  5. 5.
    Sevitt S (1955) Post-traumatic adrenal apoplexy. J Clin Pathol 8(3):185–194PubMedCrossRefGoogle Scholar
  6. 6.
    Lee YS, Jeong JJ, Nam KH, Chung WY, Chang HS, Park CS (2010) Adrenal injury following blunt abdominal trauma. World J Surg 34(8):1971–1974. doi: 10.1007/s00268-010-0537-x PubMedCrossRefGoogle Scholar
  7. 7.
    Daly KP, Ho CP, Persson DL, Gay SB (2008) Traumatic retroperitoneal injuries: review of multidetector CT findings. Radiographics 28(6):1571–1590. doi: 10.1148/rg.286075141 PubMedCrossRefGoogle Scholar
  8. 8.
    Burks DW, Mirvis SE, Shanmuganathan K (1992) Acute adrenal injury after blunt abdominal trauma: CT findings. AJR Am J Roentgenol 158(3):503–507PubMedGoogle Scholar
  9. 9.
    Stawicki SP, Hoey BA, Grossman MD, Anderson HL 3rd, Reed JF 3rd (2003) Adrenal gland trauma is associated with high injury severity and mortality. Curr Surg 60(4):431–436. doi: 10.1016/S0149-7944(02)00796-1S0149794402007961 PubMedCrossRefGoogle Scholar
  10. 10.
    Rana AI, Kenney PJ, Lockhart ME, McGwin G Jr, Morgan DE, Windham ST 3rd, Smith JK (2004) Adrenal gland hematomas in trauma patients. Radiology 230(3):669–675. doi: 10.1148/radiol.2303021345230/3/669 PubMedCrossRefGoogle Scholar
  11. 11.
    Francque SM, Schwagten VM, Ysebaert DK, Van Marck EA, Beaucourt LA (2004) Bilateral adrenal haemorrhage and acute adrenal insufficiency in a blunt abdominal trauma: a case-report and literature review. Eur J Emerg Med 11(3):164–167. doi: 00063110-200406000-00011 PubMedCrossRefGoogle Scholar
  12. 12.
    Guichelaar MM, Leenen LP, Braams R (2004) Transient adrenocortical insufficiency following traumatic bilateral adrenal hemorrhage. J Trauma 56(5):1135–1137. doi: 00005373-200405000-00032 PubMedCrossRefGoogle Scholar
  13. 13.
    Pinto A, Scaglione M, Guidi G, Farina R, Acampora C, Romano L (2006) Role of multidetector row computed tomography in the assessment of adrenal gland injuries. Eur J Radiol 59(3):355–358. doi: 10.1016/j.ejrad.2006.04.029 PubMedCrossRefGoogle Scholar
  14. 14.
    Gabal-Shehab L, Alagiri M (2005) Traumatic adrenal injuries. J Urol 173(4):1330–1331. doi: 10.1097/01.ju.0000155459.11926.61 PubMedCrossRefGoogle Scholar
  15. 15.
    Pinto A, Scaglione M, Pinto F, Gagliardi N, Romano L (2003) Adrenal injuries: spectrum of CT findings. Emerg Radiol 10(1):30–33. doi: 10.1007/s10140-003-0275-6 PubMedGoogle Scholar
  16. 16.
    Oto A, Ozgen B, Akhan O, Besim A (2000) Delayed posttraumatic adrenal hematoma. Eur Radiol 10(6):903–905PubMedCrossRefGoogle Scholar
  17. 17.
    Wang LJ, Wong YC, Chen CJ, Chu SH (2003) Imaging spectrum of adrenal pseudocysts on CT. Eur Radiol 13(3):531–535. doi: 10.1007/s00330-002-1537-5 PubMedGoogle Scholar
  18. 18.
    You JS, Chung SP, Park YS, Chung HS, Lee HS, Yu JS (2007) Isolated adrenal hemorrhage after minor blunt trauma. Am J Emerg Med 25(8):984.e5–984.e6. doi: 10.1016/j.ajem.2007.02.024 CrossRefGoogle Scholar
  19. 19.
    Favorito LA, Lott FM, Cavalcante AG (2004) Traumatic rupture of adrenal pseudocyst leading to massive hemorrhage in retroperitoneum. Int Braz J Urol 30(1):35–36PubMedCrossRefGoogle Scholar
  20. 20.
    Caoili EM, Korobkin M, Franics IR et al (2002) Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 222(3):629–633PubMedCrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2012

Authors and Affiliations

  1. 1.Department of RadiologyKeck School of Medicine of University of Southern CaliforniaLos AngelesUSA

Personalised recommendations