Adrenal hemorrhage in patients with primary antiphospholipid syndrome: imaging findings

The primary antiphospholipid syndrome consists of recurrent thromboses, early stroke, recurrent fetal loss, and livedo reticularis in patients with antiphospholipid antibodies and without systemic lupus erythematosus. The purpose of this study was to analyze the imaging findings in patients who had this syndrome as well as adrenal hemorrhage.

The medical records and reports of radiologic examinations of 228 patients with elevated titers of lupus anticoagulant or anticardiolipin antibodies from January 1992 to April 1994 were examined for indications of adrenal hemorrhage. Four patients (two men and two women 38-78 years old) were identified as having adrenal hemorrhage. The abdominal CT and MR imaging findings for three patients and autopsy data for the fourth patient were analyzed.

Adrenal hemorrhage was seen in all three patients who underwent abdominal CT and in one patient who underwent MR imaging. Adrenal hemorrhage was bilateral in three patients. Extension of hemorrhage into the perinephric space was present in two patients. Associated clinical findings probably attributable to the presence of antiphospholipid antibodies included amaurosis fugax (two patients), deep venous thrombosis (three patients), and transient ischemic attacks or stroke (two patients).

Antiphospholipid antibodies appear to be a risk factor for adrenal hemorrhage. The presence of these antibodies should be suspected in patients who have adrenal hemorrhage as well as recurrent thromboses and early stroke.