Resolution of traumatic adrenal hemorrhage on CT: impact of follow-up timing and initial hematoma size

Traumatic adrenal gland hemorrhage (TAH) is an uncommon injury which can be managed conservatively in most cases. There are limited studies assessing the interval follow-up and resolution of conservatively managed TAH. The aim of our study was to evaluate the relationship between resolution of TAH, follow-up imaging interval and initial hematoma size. A key objective was to assess the incidence of underlying adrenal masses that may mimic or contribute to hemorrhage.

Single centre retrospective cross-sectional study of all trauma patients with radiologically reported adrenal hemorrhage from January 1, 2009 to January 1, 2025. Patients were identified through radiology database search, with demographic, imaging and hematoma data collected to analyse associations between resolution, follow-up timing and initial hematoma size.

Of the 246 patients identified, 125 (51%) underwent at least 1 follow-up CT. The first follow-up occurred at a mean interval of 66.9 days; At this time, 60 patients (48%) showed complete resolution, 53 (42%) showed partial resolution and 12 (10%) demonstrated persistent hemorrhage. An underlying adrenal lesion was identified in 1% of patients. There were statistically significant associations between follow-up imaging time interval and hematoma resolution (p = 0.0025), and between the initial hematoma size and the resolution outcome (p < 0.000001).

Complete resolution of TAH occurred more frequently in patients with follow-up imaging at ≥ 30 days post injury. Hematomas measuring < 27 mm on initial imaging were more likely to resolve completely. Underlying adrenal lesions were rare. These findings may assist trauma centres in refining follow-up imaging strategies for conservatively managed TAH.