Imaging of unilateral adrenal hemorrhages in patients after blunt abdominal trauma: Report of two cases

Abstract

Adrenal hemorrhage following blunt abdominal trauma is extremely rare. Most of the lesions are unilateral and right sided. Although often asymptomatic, life-threatening adrenal insufficiency may develop in the bilateral adrenal gland hemorrhage. Isolated adrenal injuries are very rare. They are often associated with other organ injuries. The mortality rates of patients range from 7% to 32%. In this report, we present the computed tomography and magnetic resonance imaging findings of unilateral adrenal hemorrhages in two patients with a history of fall from a height.

Keywords: Adrenal glands; Blunt abdominal trauma; Computed tomography; Magnetic resonance imaging.

Fig. 1

Case 1. A 38-year-old male with a history of fall from a height. Initial abdominal computed tomography (CT) scan was performed after blunt abdominal trauma. A: Axial noncontrast CT image shows right slightly hyperdense (50 HU) soft tissue mass without periadrenal fat stranding. B: Axial contrast-enhanced CT image shows slightly hyperdense right adrenal mass with thin peripheral rim enhancement.

Fig. 2

Follow-up abdominal magnetic resonance imaging (MRI) performed 4 days later. A: Axial T₁-weighted image (TR/TE = 1.9/4.1) shows hypointense adrenal mass with small foci of high-signal intensity. B: Axial contrast-enhanced T₁ sequences (TR/TE = 1.9/4.1) shows peripherally enhancing hypointense adrenal mass with small foci of high-signal intensity.

Fig. 3

Follow-up abdominal MRI performed 30 days later. A, B: Axial T₁-weighted (TR/TE = 1.9/4.1) and axial 2D fast imaging employing steady-state acquisition sequences (TR/TE = 1.6/3.7) show hyperintense right adrenal mass with small foci of low-signal intensity.

Fig. 4

Case 2. A 35-year-old male with a history of fall from a height. Initial abdominal CT scan performed after blunt abdominal trauma. Axial noncontrast CT image revealed right subcutaneous emphysema and left slightly hyperdense (70 HU) soft-tissue mass (arrow) with periadrenal fat stranding.