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Adrenal hemorrhage (AH) can occur due to multiple etiologies with variable radiographic appearance, often indistinguishable from underlying adrenal neoplasms. There is a lack of AH literature and evidence-based guidelines. Our study aimed to understand the prevalence and etiology of AH, follow-up, and incidence of underlying neoplasm. An institutional database was queried from January 2006 to October 2021 for patients with AH on imaging, excluding patients with known malignancies, adrenal masses, or prior adrenal surgery. Demographics, medical history, hematoma size, laterality, biochemical evaluation, intervention, and additional imaging were reviewed. Of 490,301 imaging reports queried, 530 (0.11%) with AH met inclusion criteria. Most imaging (n = 485, 91.5%) was performed during trauma evaluation. Two patients underwent dedicated intervention at presentation. Interval imaging was performed in 114 (21.5%) patients at a median of 2.6 (interquartile range 0.99-13.4) mo, with resolution (n = 84, 73.7%) or decreased size of AH (n = 21, 18.4%) in most patients. Only 10 patients (1.9%) saw an outpatient provider in our system to address AH or evaluate for underlying mass, and 9 (1.7%) underwent biochemical screening. Thirteen patients (11% of 118 patients with any follow-up) had evidence of an adrenal mass, confirmed on serial imaging (n = 10) or adrenalectomy (n = 3). Scans performed for nontrauma indications were significantly more likely to have an underlying mass (n = 6/26 [23.1%]) than those performed for trauma evaluation (n = 7/92 [7.6%], P = 0.04). AH is a rare finding associated with an increased rate of underlying adrenal mass, particularly when unrelated to trauma. Most AH resolves spontaneously without intervention. Follow-up imaging at 6 mo can help distinguish mass-associated AH from simple hemorrhage. [ABSTRACT FROM AUTHOR]

There are a wide range of benign and malignant pathologies that the radiologist may encounter in the adrenal glands and kidneys, often incidentally when imaging is performed for other indications. Many imaging modalities including CT, MR, and US are often used in an attempt to characterize these lesions. A definitive radiological diagnosis, however, is not always possible. This is at times due to atypical presentations of typical lesions which may be mistaken for more aggressive or concerning pathologic conditions. Adrenal lesions that do not demonstrate characteristic benign imaging features might require surgical excision. Similarly, cystic renal lesions that demonstrate nodular enhancement are concerning for Bosniak IV lesions and require surgical management. We report 3 cases in 3 different patients of incidentally discovered hematomas with peripheral enhancement, 2 involving the adrenal gland and 1 involving the kidney. All 3 of these histologically proven hematomas demonstrated similar radiological manifestations of peripheral nodular progressive enhancement, mimicking neoplastic conditions, and necessitating surgical removal.

Due to the specific features of the adrenal glands, traumatic adrenal injury is a rare phenomenon. Themajority of these rare types of traumas are caused by blunt force injuries and rarely by penetratingmechanisms. In such cases, a whole-body computed tomography scan is essential for early diagnosis.This paper describes an uncommon case of adrenal hematoma and contusion followed by blunt abdominaltrauma. A 35-year-old woman was admitted to the emergency department after a high-speed vehicle-pedestriancollision. She presented with decreasing level of consciousness. Additionally, a thoracoabdominal CT scanrevealed a left flank hematoma. Blunt adrenal injury, often accompanied by multiorgan damage, is a rareoccurrence resulting from severe accidents. Accurate diagnosis based on clinical symptoms requires highclinical suspicion, particularly in isolated cases, and treatment depends on the patient’s condition.

ObjectiveThe detection rates of adrenal masses (AMs) have recently increased. The present study aimed to examine the clinical characteristics of these adrenal masses for guiding the clinical diagnosis and treatment among hospitalized children.MethodsThe clinical data of AM cases admitted to our hospital from January 2014 to March 2023 were collected and analyzed retrospectively. The data included composition, sex, age, initial presentation, size and site of mass, functional tumor, intervention or surgery, pathological or clinical diagnosis, and imaging data.ResultsA total of 207 hospitalized children were included. Among them, adrenal hematoma was the most common finding (53.6%), followed by adrenal neuroblastoma (36.2%). Most masses were larger-sized (51.2%) and non-functional (94.7%). We found that adrenal hematoma commonly occurred in a neonate or child with abdominal trauma. Most adrenal hematoma cases were found in male patients (63.1%), on the right side (71.2%), and with sizes 0.05). However, CT showed a priority over ultrasound in the diagnosis of neuroblastoma (P

Adrenal hemangiomas are exceedingly rare benign tumors. Hemangiomas are commonly found in the skin and liver. When they arise in the adrenal gland, they are typically found incidentally on imaging, large size at presentation and are usually surgically resected in view of their large size and heterogeneous imaging appearance. We present a 66-year-old female who presented with right abdominal pain and weight loss and was found to have a large adrenal hematoma arising from a hemangioma. • Adrenal hemangiomas are very rare, non-functioning, benign tumors that are usually incidentally detected and large in size at diagnosis. • They have varied imaging appearances however imaging can help in the diagnosis and surgical planning especially in large tumors that infiltrate into adjacent structures particularly vascular structures. Pre-operative planning with imaging can reduce the risk of operative complications. • Surgical resection is recommended in large tumors more than 4 cm in size in view of the risk of bleeding and malignancy mimicry. • Patient age, hormonal symptoms, history of non-adrenal malignancy, and biochemical test results should be considered in imaging diagnosis. [ABSTRACT FROM AUTHOR]

The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.

• AGI is an uncommon finding in blunt trauma. • Isolated adrenal injuries usually result from low force accidents. • Treatment is most commonly conservative, but depends on patient's status. • Diagnosis needs high level of clinical suspicion. Adrenal gland injury (AGI) is a rare form of trauma that is often misdiagnosed, especially if isolated. Herein we describe two rare cases of adrenal hematoma (AH) and adrenal contusion due to blunt abdominal trauma. A 33-year-old Caucasian male who was transported to the emergency department after a low-speed motorbike accident and a 69-year old Caucasian female who fell from 50 cm height. Both where complaining of intense pain in the right flank. Neither were under anti-coagulant or anti-platelet therapy. In both patients thoracoabdominal CE-CT revealed the injury. AGI is an uncommon finding in blunt trauma and isolated adrenal injuries usually result from low force accidents. Treatment is most commonly conservative, but depends on patient's status. In Greece, to our knowledge, these are the first such cases reported in adults. Diagnosis needs high level of clinical suspicion. [ABSTRACT FROM AUTHOR]

Background: Adrenal hematoma is a very rare acquired cause of neonatal hypertension. In this study, we report a case of neonatal hypertension associated with adrenal hematoma. A male neonate was immediately transferred to our neonatal intensive care unit after delivery due to meconium aspiration. He needed to be on mechanical ventilation support. During his hospital stay, hospital records showed normal blood pressure. However, 15 days after discharge, he was diagnosed with hypertension and was admitted to our Nephrology Division. Except for irritability, physical examination was normal. Blood pressure was normal, while right renal agenesis, grade two dilatation in the collective system of the left kidney, a round heterogeneous cyst (measuring 46×28 mm), and adrenal hematoma with no blood flow in the left suprarenal region were detected by ultrasound. Renal scintigraphy showed right renal agenesis, prolonged retention of the injected material in the left kidney, and a mass on the left kidney. Antihypertensive therapy was initiated for the neonate and the adrenal hematoma was checked weekly. The mass gradually shrank and his blood pressure readings returned to normal for his age. Conclusion: Neonates with hypertension and history of birth complications should be evaluated for adrenal hematoma to determine the reasons for hypertension.

The authors present a case of a 6-year-old boy operated on in the 4th week of life because of adrenal abscess. The diagnosis of an adrenal abscess in the neonatal period is challenging due to its rare occurrence and non-specifi c signs. Adrenal abscesses can develop via two mechanisms: as a result of a hematogenic infection and a spread of bacteria to “normal” adrenal glands or, which is much more common, a complication of an adrenal hematoma. Early and accurate diagnosis is crucial for appropriate therapeutic management. Imaging, including ultrasound, can be problematic. The fi nal diagnosis is frequently established on the basis of a histological examination of a surgical specimen.

We report herein a case of idiopathic adrenal hematoma. A 59-year-old Japanese man was referred to our hospital for evaluation of a 7.0 cm mass in the right upper abdominal cavity. The tumor was suspected to originate from either the posterior segment of the liver or the right adrenal gland. His chief complaint was weight loss of 8 kg over the previous 6 months. He had no past medical history and took no medications, including no anticoagulants. Laboratory data were almost normal except for a slight elevation of PIVKA-II. The origin of the tumor was found to be the adrenal gland, as angiography revealed the blood supply to the mass to derive from the right superior and inferior adrenal arteries. A fine needle biopsy of the lesion was unable to confirm the diagnosis. Open right adrenalectomy was performed. The histopathological findings of the surgical specimen revealed a hematoma with normal adrenal tissue. In the absence of any obvious etiology, the diagnosis was idiopathic adrenal hematoma.

Unilateral adrenal hemorrhages are a rare finding and when discovered they are usually due to a blunt trauma or secondary to anticoagulation therapy. We report a case of a 72-year-old Filipino male presenting with an unsuspected large adrenal mass discovered on abdominal computed tomography that was requested to evaluate a palpable soft, non-tender right lumbar mass. Characteristics of the mass on CT scan pointed to a possible adrenal neoplasm. Endocrine work up revealed a non-functioning adrenal mass. Exploratory laparotomy and resection of the retroperitoneal mass was done with a histopathologic finding of a diffuse adrenal hemorrhage.

Background: Adrenal hematoma is a very rare acquired cause of neonatal hypertension. In this study, we report a case of neonatal hypertension associated with adrenal hematoma. A male neonate was immediately transferred to our neonatal intensive care unit after delivery due to meconium aspiration. He needed to be on mechanical ventilation support. During his hospital stay, hospital records showed normal blood pressure. However, 15 days after discharge, he was diagnosed with hypertension and was admitted to our Nephrology Division. Except for irritability, physical examination was normal. Blood pressure was normal, while right renal agenesis, grade two dilatation in the collective system of the left kidney, a round heterogeneous cyst (measuring 46×28 mm), and adrenal hematoma with no blood flow in the left suprarenal region were detected by ultrasound. Renal scintigraphy showed right renal agenesis, prolonged retention of the injected material in the left kidney, and a mass on the left kidney. Antihypertensive therapy was initiated for the neonate and the adrenal hematoma was checked weekly. The mass gradually shrank and his blood pressure readings returned to normal for his age. Conclusion: Neonates with hypertension and history of birth complications should be evaluated for adrenal hematoma to determine the reasons for hypertension. [ABSTRACT FROM AUTHOR]

Aim: In the present study, our aim was to investigate demographical, clinical characteristics and outcomes of management in seven patients with hyperbilirubinemia and adrenal hemorrhage detected in abdominal ultrasonography admitted with the complaint of icterus. Materials and Methods: In this retrospective study, we reviewed the medical records of seven patients with adrenal al hematoma diagnosed with abdominal ultrasonography. Physical examination findings, blood group types, direct Coombs test, total blood count, biochemical parameter, T4, TSH, G-6-PD, CRP, total urine examination, PT, aPTT, treatment and duration of follow-up and abdominal ultrasonography findings were evaluated. Results: The presenting complaint was icterus. Two patients were females and five were males. All of the patients were born via vaginal delivery. One patient was born at home, six were born in hospital. On admission, physical examination findings revealed icterus in all cases, and there was abdominal mass in four of them. In the etiology of hyperbilirubinemia, blood group incompatibility (ABO, Rh or subgroup), hemolysis was not detected. All cases were diagnosed with adrenal hemorrhage. Adrenal hemorrhage was rightsided in 6 newborns, bilateral in 1. Adrenal insufficiency was not observed. Exchange transfusion was performed to 3 patients, and phototherapy was administered to 5. Resolution of adrenal hemorrhage was observed in ultrasonographic follow-up. Conclusion: In cases of hyperbilirubinemia of unknown etiology, adrenal hemorrhage must be kept in mind. Adrenal hematoma should also be considered in the differential diagnosis of hyperbilirubinemia. We recommend abdominal ultrasonography for further evaluation. [ABSTRACT FROM AUTHOR]

Blunt trauma to adrenal glands causing pseudoaneurysm is relatively uncommon. We report a case of an adrenal pseudoaneurysm in a young man who had a blunt abdominal trauma. The pseudoaneurysm was embolized. Pseudoaneurysm formation is a significant, albeit rare complication and can lead to adrenal hemorrhage. Currently, best treatment option is embolization. There is little known about natural course of a pseudoaneurysm, and there are no controlled trails in regard to follow up computed tomography (CT) scans in blunt solid organ injury. [ABSTRACT FROM AUTHOR]

Posttraumatic adrenal hemorrhage is a frequent finding after severe abdominal trauma and can have important clinical implications if it is bilateral. With the increased use of helical CT in the evaluation of trauma patients, posttraumatic adrenal hematoma is more frequently diagnosed. We present the CT findings of a unilateral posttraumatic adrenal hemorrhage where the diagnostic findings only appeared in the follow-up study. We think that mild enlargement of the adrenal gland in a trauma patient can be an early sign of an impending adrenal hemorrhage. [ABSTRACT FROM AUTHOR]

Background: Adrenal hematoma is a rare yet potentially life-threatening event that occurs both in traumatic conditions and in a variety of nontraumatic conditions. In the present study, we report the two cases with idiopathic unilateral adrenal hematoma. Case presentation: Case 1 involved a 72-year-old man who was complaining of upper abdominal pain. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a giant mixed density tumor in the right retroperitoneal space. To remove the tumor, we carried out an adrenalectomy on the right adrenal gland, resecting a specimen measuring 15 × 13.5 cm. The histopathological findings of the specimen revealed a hematoma with normal adrenal tissue. Case 2 involved a 53-year-old woman who complained of an uncomfortable feeling in her left upper abdomen. A retroperitoneal tumor had formed a multicystic lesion and resected because the left renal vein had become compressed. The resected specimen was 10.5 × 10 cm in size and revealed an adrenal hematoma. In the absence of any obvious etiology, the diagnoses in both cases were idiopathic adrenal hematoma. Conclusion: An accurate diagnosis of idiopathic adrenal hematoma is quite difficult to make prior to surgery. Some imaging modalities are useful in generating a differential diagnosis.

Adrenal hemorrhage is a relatively uncommon clinical problem of the newborn period. Clinical features of adrenal hemorrhage are variable. An abdominal mass, anemia, unexplained/persistent jaundice, bluish discoloration of the scrotum may be the presenting sign. Here, we presented a macrosomic infant (4150 gr) whose left side adrenal hematoma associated with asphixia and early onset of hyperbilirubinemia. We concluded that the pediatricians should be considered abdominal US screening regard as internal hemorrage in macrosomic newborns who delivered with difficult labor and then seen pathologic jaundice. [ABSTRACT FROM AUTHOR]

Abstract: Background: Adrenal hematoma is an infrequent occurrence in the setting of adult trauma care. It is typically associated with diffuse abdominal injury, and its presence is commonly correlated with high injury severity and mortality. Objectives: To discuss the recognition of adrenal hematoma as a cause of right upper quadrant pain. Case Report: We present the case of a 23-year-old man who presented to the Emergency Department (ED) with acute right upper quadrant pain after blunt trauma to the area; he was initially diagnosed with an abdominal contusion with an incidental adrenal adenoma. After experiencing continued pain for 2 days, the patient returned to the ED for re-evaluation. Subsequent imaging revealed that the adrenal mass had enlarged, and it was determined that this patient had suffered an acute adrenal hematoma. The lesion was determined to be self-limited and the patient was treated with supportive care. Follow-up images 8 weeks later revealed resolution of the hematoma and the patient reported complete resolution of symptoms. We also discuss adrenal hematoma in the trauma setting and explain that in our patient, given the clinical scenario and statistical evidence, an initial diagnosis of adrenal hematoma should be favored over abdominal contusion with incidental adenoma. Conclusion: We describe a case of a traumatic isolated adrenal hematoma that presents acutely as right upper quadrant pain. This unusual presentation highlights the need for recognition of the adrenal gland as a potential cause of right upper quadrant pain in the trauma setting. [Copyright &y& Elsevier]