Abstract
Hemorrhage of the kidneys and adrenal glands has many etiologies. In the adrenal glands, trauma, anticoagulation, stress, sepsis, surgery, and neoplasms are common causes of hemorrhage. In the kidneys, reasons for hemorrhage include trauma, bleeding diathesis, vascular diseases, infection, infarction, hemorrhagic cyst rupture, the Antopol-Goldman lesion, and neoplasms. Angiomyolipoma and renal cell carcinoma are the neoplasms most commonly associated with hemorrhage in the kidneys and adrenal cortical carcinoma, metastases, and pheochromocytoma are associated with hemorrhage in the adrenal glands. Understanding the computed tomography and magnetic resonance imaging features, and causes of hemorrhage in the kidneys and adrenal glands is critical. It is also important to keep in mind that mimickers of hemorrhage exist, including lymphoma in both the kidneys and adrenal glands, and melanoma metastases in the adrenal glands. Appropriate imaging follow-up of renal and adrenal hemorrhage should occur to exclude an underlying malignancy as the cause. If there is suspicion for malignancy that cannot be definitively diagnosed on imaging, surgery or biopsy may be warranted. Angiography may be indicated when there is a suspected underlying vascular disease. Unnecessary intervention, such as nephrectomy, may be avoided in patients with benign causes or no underlying disease. Appropriate management is dependent on accurate diagnosis of the cause of renal or adrenal hemorrhage and it is incumbent upon the radiologist to determine the etiology.
Similar content being viewed by others
References
Kawashima A, Sandler CM, Ernst RD, et al. (1999) Imaging of nontraumatic hemorrhage of the adrenal gland. Radiographics 19(4):949–963
Swensen SJ, McLeod RA, Stephens DH (1984) CT of extracranial hemorrhage and hematomas. AJR Am J Roentgenol 143(4):907–912
Furlan A, Fakhran S, Federle MP (2009) Spontaneous abdominal hemorrhage: causes, CT findings, and clinical implications. AJR Am J Roentgenol 193(4):1077–1087. doi:10.2214/AJR.08.2231
Pamuklar E, Karadeniz-Bilgili MY, Vural M, Firat Z, Semelka RC (2002) Peritoneal cavity. In: Semelka RC (ed) Abdominal-pelvic MRI, 1st edn. New York: Wiley-Liss, pp 651–693
To’o KJ, Duddalwar VA (2012) Imaging of traumatic adrenal injury. Emerg Radiol 19(6):499–503. doi:10.1007/s10140-012-1063-y
Roberts JL (1996) CT of abdominal and pelvic trauma. Semin Ultrasound CT MR 17(2):142–169
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
Rana AI, Kenney PJ, Lockhart ME, et al. (2004) Adrenal gland hematomas in trauma patients. Radiology 230(3):669–675
Lattin GE, 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(3):805–829
Rao RH (1995) Bilateral massive adrenal hemorrhage. Med Clin North Am 79(1):107–129
Chin R (1991) Adrenal crisis. Crit Care Clin 7(1):23–42
Benavente-Chenhalls LA, Vella A, Farley DR, et al. (2010) Malignant adrenal neoplasm masquerading as worrisome adrenal hemorrhage. Ann Surg Oncol 17(10):2710–2713. doi:10.1245/s10434-010-1116-y
Arora S, Vargo S, Lupetin AR (2009) Computed tomography appearance of spontaneous adrenal hemorrhage in a pheochromocytoma. Clin Imaging 33(4):314–317. doi:10.1016/j.clinimag.2008.12.008
Hanna JS, Spencer PH, Savopoulo C, Kwasnik E, Askari R (2011) Spontaneous adrenal pheochromocytoma rupture complicated by intraperitoneal hemorrhage and shock. World J Emerg Surg 6:27
Casalino DD, Miller FH, Nikolaidis P, Hammond NA (2010) Genitourinary imaging cases. China: McGraw-Hill
Rosenberg SA, Diamond HD, Jaslowitz B, Craver LF (1969) Lymphosarcoma: a review of 1269 cases. Medicine (Baltimore) 40:31–84
Zhou L, Peng W, Wang C, et al. (2012) Primary adrenal lymphoma: radiological; pathological, clinical correlation. Eur J Radiol 81(3):401–405. doi:10.1016/j.ejrad.2010.11.026
Premkumar A, Marnicola F, Taubenberger J, et al. (1996) Metastatic melanoma: correlation of MRI characteristics and histopathology. J Magn Reson Imaging 6(1):190–194
Jordan E, Poder L, Courtier J, et al. (2012) Imaging of nontraumatic adrenal hemorrhage. AJR Am J Roentgenol 199(1):W91–W98. doi:10.2214/AJR.11.7973
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(1):75–82. doi:10.1007/s00268-011-1338-6
Bosniak MA (1989) Spontaneous subcapsular and perirenal hematomas. Radiology 172(3):601–602
Blankenship JC, Gavant ML, Cox CE, Chauhan RD, Gingrich JR (2001) Importance of delayed imaging for blunt renal trauma. World J Surg 25(12):1561–1564
Bukur M, Inaba K, Barmparas G, et al. (2011) Routine follow up imaging of kidney injuries may not be justified. J Trauma 70(5):1229–1233
Goffette PP, Laterre PF (2002) Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention). Eur Radiol 12(5):994–1021
Sebastià MC, Pérez-Molina MO, Alvarez-Castells A, Quiroga S, Pallisa E (1997) CT evaluation of underlying cause in spontaneous subcapsular and perirenal hemorrhage. Eur Radiol 7(5):686–690
Zhang JQ, Fielding JR, Zou KH (2002) Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol 167(4):1593–1596
Davenport MS, Neville AN, Ellis JH, et al. (2011) Diagnosis of renal angiomyolipoma with Hounsfield unit thresholds: effect of size of region of interest and nephrograhpic phase imaging. Radiology 260:158–165
Katabathina VS, Katre R, Prasad SR, et al. (2011) Wunderlich syndrome: cross-sectional imaging review. J Comput Assist Tomogr 35(4):425–433. doi:10.1097/RCT.0b013e3182203c5e
Diaz JR, Agriantonis DJ, Aguila J, Calleros JE, Ayyappan AA (2011) Spontaneous perirenal hemorrhage: what radiologists need to know. Emerg Radiol 18(4):329–334
Cardin AL, Marshall J, Bhatt S, et al. (2008) Antopol-Goldman lesion of the kidney diagnosed by radiology: a case report of observation. Acta Radiol 49(6):715–717. doi:10.1080/02841850802056009
Eccher A, Brunelli M, Gobbo S, et al. (2009) Subepithelial pelvic hematoma (Antopol–Goldman lesion) simulating renal neoplasm: report of a case and review of the literature. Int J Surg Pathol 17(3):264–267. doi:10.1177/1066896908330482
Sheth S, Ali S, Fishman E (2006) Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics 26(4):1151–1168
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hammond, N.A., Lostumbo, A., Adam, S.Z. et al. Imaging of adrenal and renal hemorrhage. Abdom Imaging 40, 2747–2760 (2015). https://doi.org/10.1007/s00261-015-0453-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-015-0453-5