title: Persistent adrenal enhancement may be the earliest CT sign of significant hypovolaemic shock.
abstract: OBJECTIVE
  To report two cases of intense and persistent adrenal enhancement on computed tomography (CT) examinations of the abdomen.
  
  
  METHODS
  Two patients presented with septic shock, one due to pyogenic liver abscess and the other strangulated obturator hernia with gangrenous bowel. Both patients were resuscitated with fluid before undergoing unenhanced and enhanced CT.
  
  
  RESULTS
  In both patients intravascular volume was not reduced as evident by normal calibre of the aorta and inferior vena cava. One patient had abnormal enhancement pattern in the liver and kidneys, suggesting hypoperfusion. The other patient had normal enhancement pattern of the other abdominal viscera. Both patient subsequently died with multi-organ failure.
  
  
  CONCLUSIONS
  We propose that adrenal enhancement may be a sign of hyperperfusion in early stage of shock due to the crucial role of the adrenal glands in this clinical situation. This may not persist with further circulatory compromise due to vasoconstriction. If confirmed, its recognition has potential value of identifying a therapeutic window before irreversible shock set in.
authors.affiliation: Department of Radiology, Queen Mary Hospital, Pokfulam Road, SAR, Hong Kong, People's Republic of China. cheungcws@ctimail.com
authors.forename: S C W
authors.initials: SC
authors.lastname: Cheung
authors.forename: R
authors.initials: R
authors.lastname: Lee
authors.forename: H K S
authors.initials: HK
authors.lastname: Tung
authors.forename: F L
authors.initials: FL
authors.lastname: Chan
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007472:Iohexol; D008100:Liver Abscess / Q000000981:diagnostic imaging; D008875:Middle Aged; D012772:Shock, Septic / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D007472:Iohexol