Adrenal artery rupture in pregnancy

Christie, Julie; Batool, Irum; Moss, John; Macara, Lena

doi:10.1046/j.1471-0528.2003.00047.x

Cited by 13 publications

(11 citation statements)

References 8 publications

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“…Adrenal haemorrhage has clinical consequences only if followed by adrenal insufficiency 3 5 or in case of massive blood loss, in which case it can be potentially life threatening 9…”

Section: Treatmentmentioning

confidence: 99%

“…Radiological intervention can also be a viable alternative in patients who are unstable or medically unfit for major abdominal surgery. Embolisation allows preservation of any functional adrenal parenchyma and enables the patient to be stabilised, acting as a bridge to subsequent surgery 9 10…”

Section: Treatmentmentioning

confidence: 99%

“…If adrenal haemorrhage is due to adrenal venous thrombosis anticoagulation therapy is necessary 11. Surveillance in the postpartum period is required in all cases, because the stress of delivery could theoretically cause recurrent adrenal haemorrhage 5 6 9. After resorption of the haematoma, full recovery of adrenal function with discontinuation of possible steroid replacement can be expected in most cases 11…”

Section: Treatmentmentioning

confidence: 99%

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Spontaneous adrenal haemorrhage in early pregnancy

et al. 2013

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A 32-year-old primigravida presented at our emergency room at 6 weeks of gestation with acute severe right upper quadrant abdominal pain, radiating to the right flank. Vital signs were stable. Abdominal ultrasound showed a round inhomogeneous mass of 10 cm diameter behind the right kidney, suspected for adrenal haemorrhage. The patient was admitted for observation. An MRI showed some right-sided pleural effusion and a round mass in the adrenal region with no recognisable adrenal gland, therefore most likely originating from the right adrenal. After 10 days the patient was discharged with no change in size of the haematoma. MRI was carried out every 2 months which showed a decrease in size of the haematoma, with no other abnormalities. Based on stable MRI and the patient's preference, a vaginal delivery mode was chosen. At 37 weeks of gestation labour was induced, followed by an uncomplicated delivery.

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“…Adrenal haemorrhage has clinical consequences only if followed by adrenal insufficiency 3 5 or in case of massive blood loss, in which case it can be potentially life threatening 9…”

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Spontaneous adrenal haemorrhage in early pregnancy

et al. 2013

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“…Management is multidisciplinary, diagnosis is ▶ established with CT abdomen, and optimum therapeutic approach is that of adrenal artery embolisation. 6 This pdf has been created automatically from the fi nal edited text and images.…”

Section: Learning Pointsmentioning

confidence: 99%

Spontaneous adrenal haemorrhage in pregnancy

Anagnostopoulos

Sharma²

2011

Case Reports

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BACKGROUNDAdrenal haemorrhage has been reported in 0.3%-1.8% of unselected cases in autopsy studies, and its overall mortality is 15%. 1 2 The incidence in pregnancy is unknown. Nonspecifi c presentation can lead to diagnostic confusion and catastrophic delays. Diagnosis is usually made by abdominal CT, intraoperatively, rarely clinical, and on autopsy.Our personal experience from the case indicates that awareness of the condition's presentation and course is the only way to raise the suspicion of it, in the acute clinical setting. By sharing this case, we aim not only to provide knowledge, but to give an insight of how this condition can rapidly evolve. CASE PRESENTATIONA 28-year-old primigravida, at 36 +3 weeks gestation of an uncomplicated monochorionic diamniotic pregnancy, presented with acute onset right-sided chest pain. The patient was afebrile, pulse rate was 107 beats per min (bpm), blood pressure (BP), 122/77 mm Hg, tachypnoic of 20 breaths per min with oxygen saturation 99% on air. The fetal heart rate was normal for both of the twins.Clinical examination of respiratory and cardiovascular systems was normal. The abdomen and uterus found soft, non-tender and no vaginal bleeding or discharge was present. Previous medical history was unremarkable, and no history of recent trauma or febrile illness mentioned. Regular antenatal follow-up was uneventful, and an ultrasound scan for fetal growth and umbilical artery Doppler study 3 days earlier, were normal.Suspicion of pulmonary embolism, lead to initial investigation with an ECG, which revealed sinus tachycardia of 120 bpm and arterial blood gases showed Ph 7.548, PO2 16.5kPa, PCO2 2.55Kpa, base excess-3.9 meq/l and haemoglobin of 11.5 g/dl. With the pain migrating to the right fl ank and without further chest symptoms, obstetric input was sought.During the obstetric review, right abdominal fl ank tenderness along with the complaint of dysouria suggested

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“…In the literature, only a few cases of rupture of an adrenal artery have been reported [1–3]. The frequency, in nonpregnant women, varies from 0.03% to 1.8% of all visceral aneurysms [2].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Rupture of an Adrenal Artery in Pregnancy: A Case Report

Bolla

Schyrba

Drack

et al. 2012

Case Reports in Obstetrics and Gynecology

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A spontaneous rupture of an adrenal artery is a rare cause of abdominal pain in pregnancy. We present a case of a pregnant woman who needed to be operated on because of a rupture of the right adrenal artery associated with a fetal bradycardia. An immediate caesarean section was performed. The intra-abdominal palpation identified an extensive retroperitoneal mass near the right kidney and a postoperative computer tomography confirmed an active bleeding near the kidney. For this reason our interventional radiology team, using a right femoral artery approach, performed a flush aortogram and identified the source of bleeding in the right adrenal artery. After two attempts, a coiling of the artery stopped the haemorrhage. The pathogenesis of arterial haemorrhage is still poorly understood although a possible cause could be the excess of hormones during pregnancy, which can lead to a significant arterial wall degeneration. In case of a retroperitoneal bleeding and if the patient is still haemodynamically stable, a transcatheter embolization using microcoils must be considered. This technique is nowadays safe and effective and can be performed within a short time with a lower risk of complications.

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Adrenal artery rupture in pregnancy

Cited by 13 publications

References 8 publications

Spontaneous adrenal haemorrhage in early pregnancy

Spontaneous adrenal haemorrhage in early pregnancy

Spontaneous adrenal haemorrhage in pregnancy

Spontaneous Rupture of an Adrenal Artery in Pregnancy: A Case Report

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