Massive retroperitoneal adrenal hemorrhage secondary to lung cancer metastasis treated by adrenal artery embolization

The development of adrenal hemorrhage from lung cancer metastasis is extremely rare. A 54-year-old woman with stage IV non-small-cell lung cancer and known bilateral adrenal metastasis developed severe right-sided abdominal pain while undergoing chemotherapy treatment. A computerized tomography scan of the abdomen with intravenous contrast demonstrated massive right-sided retroperitoneal hemorrhage. The bleeding vessel was identified as the right middle adrenal artery. The patient underwent successful transcatheter embolization (TCE) and occlusion of the right middle adrenal artery using metallic coils, with resolution of the abdominal pain and stabilization of her hemoglobin. TCE can be used to control hemorrhage arising from metastatic involvement of the adrenal gland.