Adrenal hemorrhage

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[edit] Discussion

  • Adrenal hemorrhage occurs secondary to both traumatic conditions and atraumatic conditions.
  • Atraumatic causes of adrenal hemorrhage include:
    • Stress;
    • Hemorrhagic diathesis or coagulopathy;
    • Neonatal stress;
    • Underlying adrenal tumors;
    • Idiopathic disease.
  • The large majority of patients with adrenal hemorrhage do not have clinically obvious signs of adrenal insufficiency; the diagnosis is usually made incidentally at imaging performed for another reason.

[edit] Imaging Findings

[edit] CT

  • Adenral hematomas characteristically appear round or oval
  • Stranding of the periadrenal fat is evident as well.
  • Attenuation value of adenal hematoma depends on its age.
    • Acute to subacute hematomas contain areas of high attenuation that usually range from 50 to 90 HU.
  • Adrenal hematomas decrease in size and attenuation over time, and most resolve completely.
  • Adrenal hematoma may calcify after 1 year.
  • Organized chronic adrenal hematoma appears as a mass with a hypoattenuating center with or without calcifications. Such masses are termed adrenal pseudocysts.

[edit] US

  • Pattern of echogenicity of an adrenal hematoma depends on its age
    • Early-stage hematoma appears solid with diffuse or inhomogeneous echogenicity.
    • As liquefaction occurs, the mass demonstrates mixed echogenicity with a central hypoechoic region and eventually becomes completely anechoic and cystlike. C
    • Calcifications may be seen in the walls of the hematoma as early as 1–2 weeks after onset and gradually compact as the blood is absorbed.
  • Color Doppler and power Doppler imaging allow confirmation of the avascular nature of the mass.

[edit] MR

  • Acute stage (less than 7 days after onset): the hematoma typically appears isointense or slightly hypointense on T1-weighted images and markedly hypointense on T2-weighted images.
  • Subacute stage (7 days to 7 weeks after onset): the hematoma appears hyperintense on T1- and T2-weighted images.
  • Chronic stage (which typically begins 7 weeks after onset): a hypointense rim is present on T1- and T2-weighted images, which is attributed to hemosiderin deposition and the presence of a fibrous capsule.

[edit] Images

Patient #1: Bilateral adrenal hemorrhage

Patient #2

[edit] External Links

Goldminer: Adrenal hemorrhage

[edit] References

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