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Review
. 2017 Dec 26;11(1):358.
doi: 10.1186/s13256-017-1506-x.

Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

Anna Lehrberg  1 , Bilal Kharbutli  2
Affiliations
Review

Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

Anna Lehrberg et al. J Med Case Rep. .

Abstract

Background: Adrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries. Alternatively, isolated adrenal gland trauma is extremely rare, accounting for only 1.5 to 4% of all adrenal trauma cases. While isolated adrenal trauma is a mostly self-limiting condition, it is potentially life-threatening, representing a significant cause of bleeding, and/or hypotension due to adrenal insufficiency and adrenal crisis. Due to its rare occurrence, there are no reported guidelines for monitoring and observing isolated adrenal trauma.

Case presentation: Here we report on an isolated adrenal hemorrhage from a blunt trauma without associated injuries. A 53-year-old white man presented with abdominal pain after a high-speed motor vehicle accident. An initial evaluation revealed minimal abdominal pain and negative focused assessment with sonography for trauma examination; computed tomography imaging revealed a significant fluid collection consistent with adrenal hemorrhage. He was observed in our intensive care unit for 24 hours, and had stable hemoglobin and vital signs, after which he was discharged. At 1-month follow-up, he reported persistent intermittent abdominal pain, which was completely resolved by the 4-month follow-up.

Conclusions: This case report demonstrates isolated adrenal gland injury resulting from significant blunt trauma to the abdomen. There are no current guidelines for monitoring isolated adrenal hemorrhage. Recognizing possible adrenal injury in blunt trauma cases is important due to potentially severe adrenal hemorrhage; therefore, we recommend follow-up with serial abdominal computed tomography until the resolution of hemorrhage and symptoms.

Keywords: Adrenal; Blunt; Hemorrhage; Trauma.

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Conflict of interest statement

Ethics approval and consent to participate

The manuscript does not contain any direct patient identification details and hence ethical committee approval was waived.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Initial computed tomography scan at admission: right adrenal gland with an ovoid collection fluid consistent with blood measuring 4.6 × 2.9 cm in size with periadrenal stranding and with blood tracking along the inferior margin of the right hepatic lobe. b Coronal view of initial computed tomography at admission
Fig. 2
Fig. 2
a One-month follow-up computed tomography scan. The right adrenal gland hemorrhage had improved and reduced to 3.0 × 2.4 cm in diameter. The previously noted right periadrenal fatty stranding was almost completely resolved. b Coronal view of 1-month follow-up
Fig. 3
Fig. 3
a Four-month follow-up computed tomography scan. Improving appearance of right adrenal gland with fluid measuring maximally 1.2 cm transverse diameter and no other identifiable lesions. Periadrenal fatty stranding was completely resolved. b Coronal view at 4-month follow-up
See this image and copyright information in PMC

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