Acute adrenal injury after blunt abdominal trauma: CT findings

During a 32-month period, adrenal injuries were diagnosed in 20 (2%) of 1120 patients who had abdominal CT for assessment of blunt force trauma. Injuries were unilateral in 17 patients (12 right-sided and five left-sided) and bilateral in three (23 total adrenal injuries) and were accompanied by concurrent ipsilateral thoracic or abdominal injuries in all but one patient. Nineteen (83%) of the adrenal injuries appeared as discrete round to oval hematomas expanding the adrenal gland, two (9%) appeared as diffuse irregular hemorrhage obliterating the gland, and two (9%) appeared as uniform swelling of the adrenal gland. Associated CT findings included "stranding" of the periadrenal fat caused by blood in 14 cases (61%) and posterior pararenal hemorrhage mimicking a thickened diaphragmatic crus in nine cases (39%). In general, these injuries had no significant medical sequelae, but acute adrenal insufficiency developed in one patient with bilateral lesions; in another patient with an adrenal hematoma compressing the inferior vena cava, caval thrombosis developed. The potential for delayed bleeding or infection within the hemorrhagic gland exists, but these did not occur in any of our patients. Our experience indicates that adrenal injury resulting from blunt trauma is more common than suggested by previous reports and emphasizes the importance of careful inspection of the adrenal glands in patients in whom lower thoracic or upper abdominal injuries are detected by CT.