title: Role of multidetector row computed tomography in the assessment of adrenal gland injuries.
abstract: OBJECTIVE
  To determine the prevalence of adrenal injuries in a group of patients submitted to multidetector row CT evaluation after blunt trauma and to assess the impact of CT findings on clinical management decisions.
  
  
  METHODS
  During a 4-year period, 2026 emergency CT examinations were performed in the setting of major blunt trauma. A total of 82 patients were retrospectively identified as having adrenal gland traumatic lesions. At multidetector row CT the following findings were considered specific of adrenal injury: round or oval hematoma expanding the adrenal gland, irregular hemorrhage obliterating the gland, uniform adrenal gland swelling, active extravasation of contrast material from the adrenal vessels and adrenal gland rupture. Associated CT findings were: stranding of the periadrenal fat, diffuse hemorrhage in the adjacent retroperitoneum and compression of the adrenal gland by adjacent traumatic lesions.
  
  
  RESULTS
  We identified 82 patients (46 males and 36 females, age ranging from 15 to 86 years) with adrenal injuries. The right adrenal gland was injured in 60/82 patients, while the left adrenal gland was injured in 21 cases; in 1 patient bilateral adrenal gland traumatic lesions occurred. In 76 patients with non-isolated adrenal injuries concomitant injuries to the liver (49 cases), ipsilateral kidney (18 cases) and spleen (9 cases) were observed. Round or oval hematoma expanding the adrenal gland (61 cases), irregular hemorrhage obliterating the gland (14 cases), stranding of the periadrenal fat (9 cases) and diffuse hemorrhage in the adjacent retroperitoneum (8 cases) were the more frequent findings detected at CT. Six patients underwent surgical intervention for the presence of major injuries to the spleen (three cases), to the liver (one), to the right kidney (one), to the left kidney (one). Seventy-six patients were conservatively treated.
  
  
  CONCLUSIONS
  Blunt adrenal injuries typically present as part of a multiorgan trauma. Familiarity with characteristic CT findings of adrenal trauma is essential for the radiologist to avoid misdiagnosis.
authors.affiliation: Department of Diagnostic Imaging, A. Cardarelli Hospital, 80131 Naples, Italy. antopin1968@libero.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.forename: Mariano
authors.initials: M
authors.lastname: Scaglione
authors.forename: Guido
authors.initials: G
authors.lastname: Guidi
authors.forename: Roberto
authors.initials: R
authors.lastname: Farina
authors.forename: Ciro
authors.initials: C
authors.lastname: Acampora
authors.forename: Luigia
authors.initials: L
authors.lastname: Romano
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D000311:Adrenal Glands / Q000000981:diagnostic imaging* / Q000293:injuries*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media