title: Adrenal congestion preceding adrenal hemorrhage on CT imaging: a case series.
abstract: BACKGROUND
  Adrenal hemorrhage is an uncommon but potentially life-threatening condition, particularly in cases of bilateral adrenal hemorrhage causing primary adrenal insufficiency. It is difficult to diagnose clinically, particularly in critically ill patients, given its non-specific symptoms and signs, which include abdominal pain, vomiting, fever, weakness, hypotension, and altered conscious state. Non-traumatic adrenal hemorrhage has been observed to occur in times of physiological stress, such as post-surgery, sepsis, burns, and hypotension. This is hypothesized to be due to a combination of increased arterial blood flow to the adrenal glands, the paucity of draining adrenal venules and adrenal vein thrombosis, leading to intra-glandular vascular congestion and subsequent hemorrhage.
  
  
  METHODS
  We present four cases of non-traumatic adrenal hemorrhage, which demonstrated features of preceding adrenal congestion (adrenal gland thickening and peri-adrenal fat stranding) on computed tomography (CT) imaging. Comparison was made with 12 randomly selected intensive care patients to observe if these findings were prevalent in this subgroup of patients.
  
  
  CONCLUSIONS
  Non-traumatic adrenal hemorrhage is an uncommon condition that is difficult to diagnose clinically. As such, it may be useful to recognize CT features of adrenal congestion as a sign for potential adrenal dysfunction and subsequent adrenal hemorrhage, so early steroid replacement therapy can be commenced to prevent death from adrenal insufficiency.
authors: Department of Medical Imaging, St Vincent's Hospital Melbourne, 41, Victoria Parade, Fitzroy, VIC, 3065, Australia. gary.tan@svha.org.au.
authors: Gary Xia Vern
authors: http://orcid.org/0000-0002-4723-6358
authors: GX
authors: Tan
authors: Department of Medical Imaging, St Vincent's Hospital Melbourne, 41, Victoria Parade, Fitzroy, VIC, 3065, Australia.
authors: Tom
authors: T
authors: Sutherland
mesh_terms: D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging*; D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging*; D000368:Aged; D003287:Contrast Media; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: Adrenal congestion; Adrenal gland thickening; Adrenal hemorrhage; Peri-adrenal fat stranding; Primary adrenal insufficiency