Emergency Radiology

, Volume 22, Issue 6, pp 697–704 | Cite as

Traumatic and non-traumatic adrenal emergencies

  • Victoria Chernyak
  • Michael N. Patlas
  • Christine O. Menias
  • Jorge A. Soto
  • Ania Z. Kielar
  • Alla M. Rozenblit
  • Luigia Romano
  • Douglas S. Katz
Pictorial Essay


Multiple traumatic and non-traumatic adrenal emergencies are occasionally encountered during the cross-sectional imaging of emergency department patients. Traumatic adrenal hematomas are markers of severe polytrauma, and can be easily overlooked due to multiple concomitant injuries. Patients with non-traumatic adrenal emergencies usually present to an emergency department with a non-specific clinical picture. The detection and management of adrenal emergencies is based on cross-sectional imaging. Adrenal hemorrhage, adrenal infection, or rupture of adrenal neoplasm require immediate detection to avoid dire consequences. More often however, adrenal emergencies are detected incidentally in patients being investigated for non-specific acute abdominal pain. A high index of suspicion is required for the establishment of timely diagnosis and to avert potentially life-threatening complications. We describe cross-sectional imaging findings in patients with traumatic and non-traumatic adrenal hemorrhage, adrenal infarctions, adrenal infections, and complications of adrenal masses.


Adrenal Trauma Non-traumatic emergencies Cross-sectional imaging 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Lattin GE Jr, Sturgill ED, Tujo CA et al (2014) From the radiologic pathology archives: adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics 34:805–829CrossRefPubMedGoogle Scholar
  2. 2.
    Stawicki SP, Hoey BA, Grossman MD et al (2003) Adrenal gland trauma is associated with high injury severity and mortality. Curr Surg 60:431–436CrossRefPubMedGoogle Scholar
  3. 3.
    Rana AI, Kenney PJ, Lockhart ME et al (2004) Adrenal gland hematomas in trauma patients. Radiology 230:669–675CrossRefPubMedGoogle Scholar
  4. 4.
    Gabal-Shehab L, Alagiri M (2005) Traumatic adrenal injuries. J Urol 173:1330–1331CrossRefPubMedGoogle Scholar
  5. 5.
    Sinelnikov AO, Abujudeh HH, Chan D et al (2007) CT manifestations of adrenal trauma: experience with 73 cases. Emerg Radiol 13:313–318CrossRefPubMedGoogle Scholar
  6. 6.
    To'o KJ, Duddalwar VA (2012) Imaging of traumatic adrenal injury. Emerg Radiol 19:499–503CrossRefPubMedGoogle Scholar
  7. 7.
    Burks DW, Mirvis SE, Shanmuganathan K (1992) Acute adrenal injury after blunt abdominal trauma: CT findings. AJR Am J Roentgenol 158:503–507CrossRefPubMedGoogle Scholar
  8. 8.
    Simon DR, Palese MA (2009) Clinical update on the management of adrenal hemorrhage. Curr Urol Rep 10:78–83CrossRefPubMedGoogle Scholar
  9. 9.
    Tormos LM, Schandl CA (2013) The significance of adrenal hemorrhage: undiagnosed Waterhouse-Friderichsen syndrome, a case series. J Forensic Sci 58:1071–1074CrossRefPubMedGoogle Scholar
  10. 10.
    Hammond NA, Lostumbo A, Adam SZ, et al. (2015) Imaging of adrenal and renal hemorrhage. Abdom ImagingGoogle Scholar
  11. 11.
    Jordan E, Poder L, Courtier J et al (2012) Imaging of nontraumatic adrenal hemorrhage. AJR 199:W91–W98CrossRefPubMedGoogle Scholar
  12. 12.
    Ramon I, Mathian A, Bachelot A et al (2013) Primary adrenal insufficiency due to bilateral adrenal hemorrhage-adrenal infarction in the antiphospholipid syndrome: long-term outcome of 16 patients. J Clin Endocrinol Metab 98:3179–3189CrossRefPubMedGoogle Scholar
  13. 13.
    Bowen AD, Keslar PJ, Newman B et al (1990) Adrenal hemorrhage after liver transplantation. Radiology 176:85–88CrossRefPubMedGoogle Scholar
  14. 14.
    Boraschi P, Donati F (2004) Complications of orthotopic liver transplantation: imaging findings. Abdom Imaging 29:189–202CrossRefPubMedGoogle Scholar
  15. 15.
    Fox B (1976) Venous infarction of the adrenal glands. J Pathol 119:65–89CrossRefPubMedGoogle Scholar
  16. 16.
    Michiels JJ, Berneman Z, Schroyens W et al (2002) Bilateral adrenal swelling as a cause of chest, back, and upper abdominal pain in essential thrombocythemia and polycythemia vera is due to microvascular ischemic thrombosis rather than to hemorrhage. Ann Hematol 81:691–694CrossRefPubMedGoogle Scholar
  17. 17.
    Moschetta M, Telegrafo M, Pignatelli A, et al. (2015) Value of the CT "capsular sign" as a potential indicator of acute adrenal ischemia. Emerg RadiolGoogle Scholar
  18. 18.
    Guenette JP, Tatli S (2015) Nonhemorrhagic adrenal infarction with magnetic resonance imaging features during pregnancy. Obstet GynecolGoogle Scholar
  19. 19.
    Upadhyay J, Sudhindra P, Abraham G et al (2014) Tuberculosis of the adrenal gland: a case report and review of the literature of infections of the adrenal gland. Int J Endocrinol 2014:876037PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Glasgow BJ, Steinsapir KD, Anders K et al (1985) Adrenal pathology in the acquired immune deficiency syndrome. Am J Clin Pathol 84:594–597PubMedGoogle Scholar
  21. 21.
    Joshi P, Lele V (2014) FDG PET/CT findings in a case of nontuberculous abscess of adrenal gland. Clin Nucl Med 39:57–58CrossRefPubMedGoogle Scholar
  22. 22.
    Lam KY, Lo CY (2001) A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis. Clin Endocrinol (Oxf) 54:633–639CrossRefGoogle Scholar
  23. 23.
    Marti JL, Millet J, Sosa JA et al (2012) Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg 36:75–82CrossRefPubMedGoogle Scholar
  24. 24.
    Hatada T, Nakai T, Aoki I et al (1994) Acute abdominal symptoms caused by hemorrhagic necrosis of a pheochromocytoma: report of a case. Surg Today 24:363–367CrossRefPubMedGoogle Scholar
  25. 25.
    Gamss C, Chia F, Chernyak V et al (2009) Giant hemorrhagic myelolipoma in a patient with sickle cell disease. Emerg Radiol 16(4):319–322CrossRefPubMedGoogle Scholar
  26. 26.
    Souiki T, Tekni Z, Laachach H et al (2014) Catastrophic hemorrhage of adrenal pheochromocytoma following thrombolysis for acute myocardial infarction: case report and literature review. World J Emerg Surg 9:50PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Park JH, Kang KP, Lee SJ et al (2003) A case of a ruptured pheochromocytoma with an intratumoral aneurysm managed by coil embolization. Endocr J 50:653–656CrossRefPubMedGoogle Scholar
  28. 28.
    Newhouse JH, Heffess CS, Wagner BJ et al (1999) Large degenerated adrenal adenomas: radiologic-pathologic correlation. Radiology 210:385–391CrossRefPubMedGoogle Scholar
  29. 29.
    Cheungpasitporn W, Horne JM, Howarth CB (2011) Adrenocortical carcinoma presenting as varicocele and renal vein thrombosis: a case report. J Med Case Rep 5:337PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2015

Authors and Affiliations

  • Victoria Chernyak
    • 1
  • Michael N. Patlas
    • 2
    • 8
  • Christine O. Menias
    • 3
  • Jorge A. Soto
    • 4
  • Ania Z. Kielar
    • 5
  • Alla M. Rozenblit
    • 1
  • Luigia Romano
    • 6
  • Douglas S. Katz
    • 7
  1. 1.Department of RadiologyMontefiore Medical CenterBronxUSA
  2. 2.Division of Emergency/Trauma Radiology, Department of RadiologyMcMaster UniversityHamiltonCanada
  3. 3.Department of RadiologyMayo Clinic School of MedicineScottsdaleUSA
  4. 4.Department of RadiologyBoston UniversityBostonUSA
  5. 5.Division of Abdominal and Pelvic Imaging, Ottawa HospitalUniversity of OttawaOttawaCanada
  6. 6.Department of RadiologyCardarelli HospitalNaplesItaly
  7. 7.Department of RadiologyWinthrop-University HospitalMineolaUSA
  8. 8.Division of Emergency/Trauma Radiology, Department of RadiologyHamilton General HospitalHamiltonCanada

Personalised recommendations