Spontaneous retroperitoneal hemorrhage localized by blood pool scintigraphy.
A healthy 17-year-old girl presented to the emergency department with a 1-day history of left upper quadrant abdominal pain associated with nausea and vomiting. Her hematocrit was 22. On physical examination, she had left upper quadrant fullness and tenderness. Initial computed tomography revealed a large, loculated, left-sided retroperitoneal hematoma. Blood pool scintigraphy with labeled red cells revealed a very large photon-deficient area with 3 areas of active bleeding in the upper margin of the cold area. An angiogram showed active extravasation from the left inferior phrenic artery. The patient was felt to have had spontaneous adrenal hemorrhage, likely within a preexisting, large adrenal cyst. Spontaneous hemorrhage into an adrenal cyst is a rare entity that can be life-threatening if not treated early in its course.
Lerer
Daniel B
DB
Department of Nuclear Medicine and Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Rozenblit
Alla M
AM
Cynamon
Jacob
J
Tubman
Gary
G
Freeman
Leonard M
LM
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006470:Hemorrhage / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006801:Humans; D009325:Nausea / Q000209:etiology; D012187:Retroperitoneal Space / Q000098:blood supply* / Q000000981:diagnostic imaging*; D014839:Vomiting / Q000209:etiology