Multi-detector computed tomography in the diagnosis and characterization of adrenal gland traumatic injuries

Abstract

Adrenal gland injuries after a blunt abdominal trauma are rare events and represent important indicators for severe trauma. Multidetector CT evolution with high volumetric resolution and fast acquisition with the use of multiplanar reformatted (MPR) visualization allows for an accurate and fast diagnosis of the adrenal gland for post-traumatic pathologies. While, before its introduction the diagnosis was made mainly postmortem or during surgery. Adrenal injuries are unilateral up to 90% of the cases involving most commonly the right gland; thoracoabdominal organs injuries are often also associated. Bilateral adrenal lesions are asymptomatic, potentially leading to the development of acute adrenal insufficiency. The purpose of the present review was to determine the prevalence, the mechanism of injury and the different CT appearances of adrenal trauma. Prognosis and management of adrenal injury will also be reviewed.

Life-threatening Hypotension in a Multi-trauma-brain Injured Patient With Unilateral Adrenal Gland Damage; a Single Hydrocortisone Dose Unraveled Relative Corticosteroid Insufficiency.

“…1,2,3 Identi cation of adrenal injury can be of critical importance in patients with bilateral adrenal injury, which may lead to acute adrenal insu ciency and death, whereas unilateral adrenal trauma is often asymptomatic and masked by injuries to other organs. 1,3,4 However, when unilateral adrenal trauma is associated with multiple injuries including brain trauma, as in our case, critical illness-related corticosteroid insu ciency (CIRCI) may be present; despite the importance, criteria for the diagnosis are not well established.…”

Multimodality Imaging Findings in Waterhouse-Friderichsen Syndrome: A Case Report and a Short Literature Review

“…It usually shows adrenal hematomas that characteristically appear round or oval, often with surrounding strandings of the periadrenal fat. In rare cases, if arterial active bleeding is occurring, a post-contrast blush might be also detected [15,16]. A condition named "adrenal congestion", which consists in thickening of adrenal glands and the stranding of the periadrenal fat, can be occasionally detected before the hemorrhage [17].…”

“…Adrenal hematomas can typically be detected in the non-contrast phase, where they appear as round to ovoid lesions, usually associated with periadrenal fat stranding and, sometimes, the involvement of the peri-nephric space. The acquisition of post-contrast phases (arterial, venous, and excretory) is crucial to detect any presence of active bleeding, seen as an arterial "blush" [15].…”

Life-Threatening Hypotension in a Brain-Injured, Multi-Trauma Patient With Unilateral Adrenal Gland Damage: How a Single Hydrocortisone Dose Revealed Relative Corticosteroid Insufficiency

“…The incidence of adrenal injury after trauma is very rare [1][2][3]. Identification of adrenal injury can be of critical importance in patients with bilateral adrenal injury, which may lead to acute adrenal insufficiency and death, whereas unilateral adrenal trauma is often asymptomatic and masked by injuries to other organs [1,3,4]. However, when unilateral adrenal trauma is associated with multiple injuries including brain trauma, as in our case, critical illness-related corticosteroid insufficiency (CIRCI) may be present; despite the importance of timely action, criteria for the diagnosis are not well established.…”