Acute adrenal hemorrhage after blunt trauma.
OBJECTIVE
To determine the appropriate management of adrenal hemorrhage in patients with severe chest and upper abdominal blunt trauma.


METHODS
We reviewed 7 patients who suffered from severe traumatic adrenal hemorrhage after a traffic accident (n = 4) or fall (n = 3). Contrast-enhanced CT images were analyzed for multi-organ traumatic injury, hematoma size, extravasation, and pseudoaneurysm formation. We also report their management including transarterial embolization (TAE) and follow-up findings.


RESULTS
All 7 patients manifested multi-organ traumatic injury and hemothorax; 5 also had rib fractures, 5 had abdominal organ injuries (liver, n = 3; kidneys, n = 2; pancreas, n = 1); 2 had dorsal fractures, and 1 had a traumatic aortic aneurysm. On CT images, unilateral right adrenal hematomas ranging from 20 to 50 mm (mean 26 mm) in length and from 15 to 50 mm (mean 23 mm) in width were seen. In 6 patients these were localized, and they were followed without any intervention. The other patient had a massive hematoma with pseudoaneurysm and extravasation, who subsequently received TAE. At 3-month follow-up all patients were doing well.


CONCLUSIONS
Information regarding the size of the hematoma and the presence of extravasation helps to select the appropriate management of patients with traumatic adrenal hemorrhage. TAE appears to be useful for treating patients with massive adrenal hemorrhage.
Ikeda
O
O
Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1 Honjo, Kumamoto 860-8556, Japan. osamu-3643ik@do9.enjoy.ne.jp
Urata
Joji
J
Araki
Yushi
Y
Yoshimatsu
Shunji
S
Kume
Shuichi
S
Torigoe
Yoshitsugu
Y
Yamashita
Yasuyuki
Y
D000063:Accidents, Traffic; D000311:Adrenal Glands / Q000000981:diagnostic imaging* / Q000293:injuries*; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000628:therapy; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications*
D003287:Contrast Media