Multi-detector computed tomography in the diagnosis and characterization of adrenal gland traumatic injuries

Abstract

Adrenal gland injuries after a blunt abdominal trauma are rare events and represent important indicators for severe trauma. Multidetector CT evolution with high volumetric resolution and fast acquisition with the use of multiplanar reformatted (MPR) visualization allows for an accurate and fast diagnosis of the adrenal gland for post-traumatic pathologies. While, before its introduction the diagnosis was made mainly postmortem or during surgery. Adrenal injuries are unilateral up to 90% of the cases involving most commonly the right gland; thoracoabdominal organs injuries are often also associated. Bilateral adrenal lesions are asymptomatic, potentially leading to the development of acute adrenal insufficiency. The purpose of the present review was to determine the prevalence, the mechanism of injury and the different CT appearances of adrenal trauma. Prognosis and management of adrenal injury will also be reviewed.

Keywords: Emergency radiology; adrenal glands; adrenal injuries; blunt abdominal trauma; hematoma; hemorrhage; multi-detector computed tomography (MDCT); trauma imaging.

Figure 1

Contrast enhanced multi-detector computed tomography (CE-MDCT) shows lacerations of the right lobe of the liver (VI segment) (black arrow), devascularization of the right kidney (black arrowhead), and hematoma of the right adrenal gland (white arrow). (A) A subtle perihepatic fluid collection is seen (white arrowhead).

Figure 2

Contrast enhanced multi-detector computed tomography (CE-MDCT). (A) Axial scan; (B) coronal reconstruction. CT shows lacerations of the right lobe of the liver (black arrows), contusion of the spleen (black arrowhead), laceration of the right kidney (white arrowhead) and right adrenal hemorrhage (white asterisk), with a little focus of active bleeding (white arrow). Perisplenic fluid collection is also seen (black asterisk).

Figure 3

Contrast enhanced multi-detector computed tomography (CE-MDCT), axial scan. CT shows right adrenal hematoma, expanding the gland (white arrow).

Figure 4

Contrast enhanced multi-detector computed tomography (CE-MDCT). (A) Axial scan; (B) coronal reconstruction. CT shows a subtle right adrenal hematoma, with a thin enhanced peripheral rim (black arrow). A huge hepatic laceration is seen (white arrow) with a traumatic intrahepatic pseudoaneurysm (white arrowhead). A subcapsular hepatic hematoma is also appreciable (white asterisk).

Figure 5

Contrast enhanced multi-detector computed tomography (CE-MDCT). (A) Axial scan, arterial phase; (B) axial scan, venous phase; (C) coronal reconstruction, arterial phase. CT demonstrates a large right adrenal hematoma (white arrow) displacing the inferior vena cava and the right hepatic vein (black arrowhead).

Figure 6

Contrast enhanced multi-detector computed tomography (CE-MDCT). (A) Axial scan, arterial phase; (B) axial scan, venous phase; (C) coronal reconstruction, arterial phase. CT shows a huge retroperitoneal hemorrhage. A large focus of active bleeding is seen, which is already well evident in the arterial phase (white arrow) and enlarge in the arterial phase (white arrowhead). The active bleeding is due to the right adrenal artery tearing.

Figure 7

Contrast enhanced multi-detector computed tomography (CE-MDCT), axial scans. CT shows a right adrenal irregular hemorrhage (white arrow) obliterating the gland. A right hepatic lobe laceration (black arrow), laceration of the spleen (black arrowhead) and perihepatic and perisplenic fluid collection (white asterisk) are also seen.

Figure 8

Contrast enhanced multi-detector computed tomography (CE-MDCT). (A) Axial scan, arterial phase; (B) axial scan, venous phase; (C) coronal reconstruction, arterial phase. CT shows right adrenal hematoma as an adrenal gland enlargement (white arrow). Laceration of the right hepatic lobe (black arrow) and a subtle perihepatic fluid collection (white asterisk) are also seen.

Figure 9

Contrast enhanced multi-detector computed tomography (CE-MDCT). (A) Axial scan; (B) coronal reconstruction; (C) sagittal reconstruction. CT shows a right adrenal hematoma, enlarging the gland (white arrow). Inferior vena cava is compressed and displaced (black arrow). It is also appreciable the periadrenal fat tissue thickening (white arrowhead). There is also a fracture of the right hemipelvis (black arrowhead).

Figure 10

Contrast enhanced multi-detector computed tomography (CE-MDCT). (A) Axial scan; (B) sagittal reconstruction. CT shows a right adrenal hematoma (white asterisk), associated with stranding of the periadrenal fat tissue (white arrow). It is also appreciable thickening of the right diaphragmatic crus (black asterisk). A large intrahepatic hematoma is also seen (black arrow).