Posttraumatic adrenal hemorrhage in children: CT findings in 34 patients

The medical records and CT scans of 34 children with posttraumatic adrenal hemorrhage were reviewed. Adrenal hemorrhage was unilateral in 32 children; most injuries were on the right side. Bilateral hemorrhage was present in two children. The injured gland was oval in 27 cases and triangular in nine. Gland size ranged from 7 to 45 mm long and 4 to 30 mm wide. All adrenal hemorrhages had decreased attenuation relative to liver and spleen on contrast-enhanced CT. Ipsilateral diaphragmatic crural thickening was a frequent (61%) associated finding. Ipsilateral intraabdominal (61%) and intrathoracic (44%) injuries were often present. Clinical signs of adrenocortical insufficiency were not observed in any child. In summary, posttraumatic adrenal hemorrhage is uncommon in children. The hemorrhage is usually unilateral, right sided, and associated with ipsilateral visceral injury.