Isolated Post-traumatic Adrenal Hematoma: Detection by Bedside Ultrasound in the Emergency Department

Huang, Yen‐Chang; Lee, Wei-Jing; Lin, Hung‐Jung; Yang, Po‐Jen

doi:10.1016/j.jemermed.2009.08.052

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…In addition, the AGT observed here is similar to the other cases reporting similar injury with regard to its being unilateral and right sided [ 3 , 7 , 13 , 15 ]. In a retrospective analysis of trauma patients, Mehrazin et al .…”

Section: Discussionsupporting

confidence: 88%

“…The AGT injury presented here shares a number of similarities with the few previously reported cases of isolated unilateral AGT [ 3 , 13 – 15 ]. Like most other cases of AGT, the major complaint in this case was abdomen pain in the right upper quadrant [ 3 , 13 – 15 ]. However, an unusual aspect of this case that differentiates it from other unilateral adrenal injuries is that the pain was mild; a failure to report the severity of pain may result in underreporting of this type of injury.…”

Section: Discussionsupporting

confidence: 78%

“…Adrenal gland injuries are usually associated with other life-threatening injuries [ 1 , 2 , 12 ]. Accordingly, cases of isolated traumatic unilateral adrenal gland injuries are rare [ 3 , 13 – 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

Lehrberg

Kharbutli

2017

J Med Case Reports

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BackgroundAdrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries. Alternatively, isolated adrenal gland trauma is extremely rare, accounting for only 1.5 to 4% of all adrenal trauma cases. While isolated adrenal trauma is a mostly self-limiting condition, it is potentially life-threatening, representing a significant cause of bleeding, and/or hypotension due to adrenal insufficiency and adrenal crisis. Due to its rare occurrence, there are no reported guidelines for monitoring and observing isolated adrenal trauma.Case presentationHere we report on an isolated adrenal hemorrhage from a blunt trauma without associated injuries. A 53-year-old white man presented with abdominal pain after a high-speed motor vehicle accident. An initial evaluation revealed minimal abdominal pain and negative focused assessment with sonography for trauma examination; computed tomography imaging revealed a significant fluid collection consistent with adrenal hemorrhage. He was observed in our intensive care unit for 24 hours, and had stable hemoglobin and vital signs, after which he was discharged. At 1-month follow-up, he reported persistent intermittent abdominal pain, which was completely resolved by the 4-month follow-up.ConclusionsThis case report demonstrates isolated adrenal gland injury resulting from significant blunt trauma to the abdomen. There are no current guidelines for monitoring isolated adrenal hemorrhage. Recognizing possible adrenal injury in blunt trauma cases is important due to potentially severe adrenal hemorrhage; therefore, we recommend follow-up with serial abdominal computed tomography until the resolution of hemorrhage and symptoms.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 78%

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Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

Lehrberg

Kharbutli

2017

J Med Case Reports

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“…A normal adrenal gland may be difficult to locate with US, but normally can be readily identified when enlarged and surrounded by a hematoma, and more clearly with CEUS. On follow-up US, an adrenal gland hematoma should alter from a rounded and isoechoic area (compared to the surrounding hyperechoic fat) gradually becoming hypo-or anechoic [28,29]. An alternative imaging strategy for following up children with adrenal injuries should involve US with the addition of CEUS.…”

Section: Discussionmentioning

confidence: 99%

Pediatric adrenal trauma: evaluation and follow-up with contrast-enhanced ultrasound (CEUS)

et al. 2016

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Adrenal trauma is rarely encountered in the pediatric population, often as a component of multi-organ injury and often presenting with hematoma formation. Contrast-enhanced computed tomography (CECT) is the established imaging modality both for initial evaluation and follow-up of patients with blunt abdominal trauma. In children, radiation exposure should be minimized and alternative imaging strategies are needed. Contrast-enhanced ultrasound (CEUS) has recently been successfully used for evaluation of patients with hepatic, renal and splenic injury. We present three cases of children with post-traumatic adrenal hematomas, which were initially diagnosed with CECT and subsequently followed up with CEUS, suggesting that CEUS may be considered for follow-up of adrenal injuries in children. CEUS improves the diagnostic capabilities by increasing tissue contrast and spatial resolution, readily differentiating viable from necrotic tissue in comparison to conventional ultrasound without the risk of iodine contrast agents and ionizing radiation of repeated CECT examinations.

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“…Isolated trauma to the adrenal gland is a rare and underreported injury, with an incidence of between 1.5% and 4% of all adrenal trauma cases [1][2][3][4]. Due to its unique anatomy and the mechanism required to result in an isolated injury, adrenal injury is typically unilateral and right-sided [2,[5][6][7][8]. Adrenal gland injury is rare due to its small size, deep retroperitoneal position, and presence of fatty tissue surrounding it; however, the adrenal glands are vulnerable to bleeding due to their extensive network of collateral circulation [9].…”

Section: Introductionmentioning

confidence: 99%

A Rare Case of an Isolated Left Adrenal Haematoma in Blunt Force Trauma

Izwan¹,

Anderson²

2022

Cureus

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Isolated left adrenal gland injuries following blunt abdominal trauma are extremely rare, accounting for only 1.5-4% of all adrenal trauma cases. Most traumatic injuries are right-sided and associated with other concurrent organ injuries. While acute, unilateral adrenal injuries can be asymptomatic, it is important to recognise the potentially life-threatening complications from haemorrhage and/or adrenal insufficiency. Due to its rarity, there are currently no established guidelines for management, monitoring, or follow-up of adrenal gland trauma. We present a case report of a rare, isolated, post-traumatic left adrenal gland haemorrhage. A 39-year-old man presented with mild abdominal pain following a mountain bike accident. Initial assessment revealed tenderness in the left upper quadrant with normal vital signs and biochemistry, but computer tomography (CT) imaging demonstrated an enlarged left adrenal gland with regional fat stranding and free fluid consistent with an acute adrenal haematoma. He was admitted to the ward for observation and discharged on day three of admission. At a six-week follow-up, he reported a complete resolution in symptoms. Follow-up CT of the adrenals at five months post-injury demonstrated complete resolution of the isolated adrenal haematoma. Post-traumatic isolated left adrenal gland injuries are rare in the reported literature, and this case highlights the lack of current guidelines for management and monitoring in cases of isolated adrenal haemorrhage. The current consensus appears to be appropriate with conservative management and follow-up with serial abdominal CT until the resolution of haemorrhage and/or symptoms.

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Isolated Post-traumatic Adrenal Hematoma: Detection by Bedside Ultrasound in the Emergency Department

Cited by 5 publications

References 5 publications

Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

Isolated unilateral adrenal gland hemorrhage following motor vehicle collision: a case report and review of the literature

Pediatric adrenal trauma: evaluation and follow-up with contrast-enhanced ultrasound (CEUS)

A Rare Case of an Isolated Left Adrenal Haematoma in Blunt Force Trauma

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