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Case Reports
. 2020:67:34-38.
doi: 10.1016/j.ijscr.2020.01.021. Epub 2020 Jan 27.

Adrenal gland injury after blunt abdominal trauma: Two case series and review of the literature

Konstantinos S Papadopoulos  1 , Konstantinos Strigklis  2 , Kleoniki Kordeni  3 , Panagiota Xaplanteri  4 , Georgios Zacharis  5
Affiliations
Case Reports

Adrenal gland injury after blunt abdominal trauma: Two case series and review of the literature

Konstantinos S Papadopoulos et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Adrenal gland injury (AGI) is a rare form of trauma that is often misdiagnosed, especially if isolated.

Presentation of case: Herein we describe two rare cases of adrenal hematoma (AH) and adrenal contusion due to blunt abdominal trauma. A 33-year-old Caucasian male who was transported to the emergency department after a low-speed motorbike accident and a 69-year old Caucasian female who fell from 50 cm height. Both where complaining of intense pain in the right flank. Neither were under anti-coagulant or anti-platelet therapy. In both patients thoracoabdominal CE-CT revealed the injury.

Discussion: AGI is an uncommon finding in blunt trauma and isolated adrenal injuries usually result from low force accidents. Treatment is most commonly conservative, but depends on patient's status. In Greece, to our knowledge, these are the first such cases reported in adults.

Conclusion: Diagnosis needs high level of clinical suspicion.

Keywords: Adrenal gland injury; Adrenal hematoma; Blunt abdominal trauma.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Oval, well-defined lesion (4.2 × 2.7) with high density (green arrow) and crus thickening (yellow arrow), indicative of acute AH in the initial abdominal CT. No contrast extravasation is noticed. Periadrenal fat stranding appears inferiorly (circle).
Fig. 2
Fig. 2
7-day follow-up MRI shows hypointense enlargement of the right adrenal (arrow) in T1 and an anomeogenous gland with hyperintense elements possibly haemorrhagic in diffuse weighted imaging (DWI).
Fig. 3
Fig. 3
Close affiliation of the structures is shown through the first follow-up MRI, posterior to the injured adrenal gland seems not only compressed between the liver and the vertebrae, but also reshaped in contact with the latter.
Fig. 4
Fig. 4
60-day follow-up reveals a greatly reduced lesion typical of a chronic AH (arrow) with hypointense T1 signal and iso- to hypointense lesion with slight hyperintense capsule in T2 sequence (circle) with maximum diameter at 1.3 cm.
Fig. 5
Fig. 5
CE-CT reveals a contrast-enhanced dot-shaped focal area anterior to the gland (arrow).
Fig. 6
Fig. 6
Plain abdominal CT follow-up imaging after three days shows a distinct hypodense area of the non-traumatic oval lesion and a smaller posterior hyperdense area (55 HU) of the gland close to the liver. Notice the three different density areas around the gland (a,b,c).
See this image and copyright information in PMC

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