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Imaging of Nontraumatic Hemorrhage of the Adrenal Gland¹

¹ From the Departments of Radiology (A.K., C.M.S., R.D.E., N.T., S.M.G.) and Urology (C.M.S., S.M.G.), University of Texas–Houston Medical School; the Department of Radiology, Lyndon B. Johnson General Hospital, 5656 Kelley St, Houston, TX 77026 (A.K., C.M.S., R.D.E.); the Department of Radiology, University of Michigan Medical Center, Ann Arbor (M.A.R., N.R.D.); and the Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Md (E.K.F.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1997 RSNA scientific assembly. Received December 8, 1998; revision requested February 2, 1999, and received March 8; accepted March 11. Address reprint requests to A.K.

Nontraumatic hemorrhage of the adrenal gland is uncommon. The causes of such hemorrhage can be classified into five categories: (a) stress, (b) hemorrhagic diathesis or coagulopathy, (c) neonatal stress, (d) underlying adrenal tumors, and (e) idiopathic disease. Computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging play an important role in diagnosis and management. CT is the modality of choice for evaluation of adrenal hemorrhage in a patient with a history of stress or a hemorrhagic diathesis or coagulopathy (anticoagulant therapy). CT may yield the first clue to the diagnosis of adrenal insufficiency secondary to bilateral massive adrenal hemorrhage; such insufficiency is rare but life threatening. US is the modality of choice for evaluation of neonatal hematoma, and MR imaging is helpful for further characterization. MR imaging is also useful in the diagnosis of coexistent renal vein thrombosis. When an adrenal abscess is suspected, percutaneous aspiration and drainage under imaging guidance should be performed. Hemorrhage into an adrenal cyst or tumor can cause acute onset of symptoms and signs in a patient without discernible risk factors for adrenal hemorrhage. A hemorrhagic adrenal tumor should be suspected when CT or MR imaging reveals a hemorrhagic adrenal mass of heterogeneous attenuation or signal intensity that demonstrates enhancement.

Index Terms: Adrenal gland, abnormalities, 86.18 • Adrenal gland, abscess, 86.211 • Adrenal gland, CT, 86.1211 • Adrenal gland, hemorrhage, 86.546 • Adrenal gland, insufficiency, 86.549 • Adrenal gland, MR, 86.1214 • Adrenal gland, neoplasms, 86.30 • Adrenal gland, US, 86.1298

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