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Adrenal Gland Hematomas in Trauma Patients¹

¹ From the Departments of Radiology (A.I.R., P.J.K., M.E.L., D.E.M., J.K.S.), Epidemiology and International Health (G.M.), and Surgery-General Surgery (S.T.W.), University of Alabama at Birmingham, 619 S 19th St, Birmingham, AL 35249. Received October 16, 2002; revision requested December 23; final revision received August 4, 2003; accepted August 6. Address correspondence to P.J.K. (e-mail: pkenney@uabmc.edu).

View larger version (185K): [in a new window]   Figure 1a. Transverse contrast material-enhanced CT images obtained in 29-year-old man injured in motor vehicle collision. Radiologic evaluation revealed right rib fractures and bilateral pleural effusions, and his ISS was 22. This patient survived, spent 1 day in the intensive care unit, and was discharged after spending 5 days in the hospital. (a) Initially obtained trauma CT image shows laceration (arrows) of right liver lobe. (b) Follow-up CT image obtained 1 month after trauma CT was performed shows 3-cm right adrenal mass (arrow) with an attenuation of 52 HU. Note the stranding (arrowheads) in the periadrenal fat. (c) Follow-up CT image obtained 1 month later shows the attenuation and size of the mass in b decreased to 33 HU and 2 cm, respectively.

View larger version (178K): [in a new window]   Figure 1b. Transverse contrast material-enhanced CT images obtained in 29-year-old man injured in motor vehicle collision. Radiologic evaluation revealed right rib fractures and bilateral pleural effusions, and his ISS was 22. This patient survived, spent 1 day in the intensive care unit, and was discharged after spending 5 days in the hospital. (a) Initially obtained trauma CT image shows laceration (arrows) of right liver lobe. (b) Follow-up CT image obtained 1 month after trauma CT was performed shows 3-cm right adrenal mass (arrow) with an attenuation of 52 HU. Note the stranding (arrowheads) in the periadrenal fat. (c) Follow-up CT image obtained 1 month later shows the attenuation and size of the mass in b decreased to 33 HU and 2 cm, respectively.

View larger version (196K): [in a new window]   Figure 1c. Transverse contrast material-enhanced CT images obtained in 29-year-old man injured in motor vehicle collision. Radiologic evaluation revealed right rib fractures and bilateral pleural effusions, and his ISS was 22. This patient survived, spent 1 day in the intensive care unit, and was discharged after spending 5 days in the hospital. (a) Initially obtained trauma CT image shows laceration (arrows) of right liver lobe. (b) Follow-up CT image obtained 1 month after trauma CT was performed shows 3-cm right adrenal mass (arrow) with an attenuation of 52 HU. Note the stranding (arrowheads) in the periadrenal fat. (c) Follow-up CT image obtained 1 month later shows the attenuation and size of the mass in b decreased to 33 HU and 2 cm, respectively.

View larger version (205K): [in a new window]   Figure 2a. Transverse contrast-enhanced CT images obtained in 45-year-old man injured in motor vehicle collision. Radiologic evaluation revealed left rib fracture, transverse process fractures, and bilateral renal injuries; his ISS was 8. This patient was discharged after spending 5 days in the hospital. (a) Initially obtained trauma CT image shows rib fractures (arrow) and adjacent perisplenic hematoma, without frank splenic rupture. (b) Another initial trauma CT image shows 3.5-cm left adrenal hematoma (arrow) with an attenuation of 37 HU. Note the perisplenic hematoma (arrowheads). The right adrenal gland (not shown) was normal.

View larger version (208K): [in a new window]   Figure 2b. Transverse contrast-enhanced CT images obtained in 45-year-old man injured in motor vehicle collision. Radiologic evaluation revealed left rib fracture, transverse process fractures, and bilateral renal injuries; his ISS was 8. This patient was discharged after spending 5 days in the hospital. (a) Initially obtained trauma CT image shows rib fractures (arrow) and adjacent perisplenic hematoma, without frank splenic rupture. (b) Another initial trauma CT image shows 3.5-cm left adrenal hematoma (arrow) with an attenuation of 37 HU. Note the perisplenic hematoma (arrowheads). The right adrenal gland (not shown) was normal.

View larger version (170K): [in a new window]   Figure 3a. Transverse contrast-enhanced CT images obtained in 36-year-old woman injured in motor vehicle collision. Radiologic evaluation revealed bilateral pneumothoraces, pneumomediastinum, left pleural effusion, and lumbar and sacral fractures; her ISS was 45. The patient died within 24 hours after the collision. (a) Initially obtained trauma CT image shows right liver lobe laceration (arrowheads), splenic laceration, and bilateral adrenal hematomas (arrows). The right adrenal hematoma was 4.2 cm in diameter and had an attenuation of 32 HU; the left adrenal hematoma was 3.8 cm in diameter and had an attenuation of 38 HU. (b) Another initial CT image shows pancreatic laceration (arrow) and a retroperitoneal hemorrhage.

View larger version (164K): [in a new window]   Figure 3b. Transverse contrast-enhanced CT images obtained in 36-year-old woman injured in motor vehicle collision. Radiologic evaluation revealed bilateral pneumothoraces, pneumomediastinum, left pleural effusion, and lumbar and sacral fractures; her ISS was 45. The patient died within 24 hours after the collision. (a) Initially obtained trauma CT image shows right liver lobe laceration (arrowheads), splenic laceration, and bilateral adrenal hematomas (arrows). The right adrenal hematoma was 4.2 cm in diameter and had an attenuation of 32 HU; the left adrenal hematoma was 3.8 cm in diameter and had an attenuation of 38 HU. (b) Another initial CT image shows pancreatic laceration (arrow) and a retroperitoneal hemorrhage.

View larger version (153K): [in a new window]   Figure 4. Transverse contrast-enhanced trauma CT image obtained in 23-year-old man ejected from automobile in rollover motor vehicle accident. At arrival in the emergency department, the patient had no detectable blood pressure but was resuscitated. Radiologic evaluation revealed bilateral pneumothoraces and multiple rib, lumbar, sacral, and femur fractures. This patient died in less than 12 hours after admission. Note the active extravasation (arrow) of vascular contrast material from the adrenal gland. This patient had an extensive retroperitoneal hematoma and a 6-cm right adrenal hematoma.