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| CASE REPORT |
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| Year : 2015 | Volume
: 4
| Issue : 1 | Page : 27-29 |
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Posttraumatic isolated adrenal hematoma: A report of two cases
Debanga Sarma, TP Rajeev, Somor Jyoti Bora, Sasanka Kr Barua
Department of Urology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| Date of Web Publication | 19-Nov-2015 |
Correspondence Address:
Dr. Debanga Sarma
Department of Urology, Gauhati Medical College and Hospital, Guwahati, Assam
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1597-1112.169813
Isolated posttraumatic adrenal hematoma is a very rare entity. Only, few cases have been reported in the literature. We present here 2 cases of isolated posttraumatic adrenal hematoma. Both the cases presented due to blunt trauma abdomen following road traffic accident with pain in the right flank. Contrast enhanced computed tomography abdomen showed adrenal mass with an attenuation of 62 HU and 68 HU which were compatible with traumatic adrenal hematoma. Both cases were managed conservatively. Keywords: Adrenal hematoma, adrenal mass, blunt trauma
How to cite this article:
Sarma D, Rajeev T P, Bora SJ, Barua SK. Posttraumatic isolated adrenal hematoma: A report of two cases. Afr J Trauma 2015;4:27-9 |
| Introduction | |  |
Adrenal gland injury is a rare finding in blunt trauma abdomen, because of its location; but due to increased use of helical computed tomography (CT) for evaluation of trauma, posttraumatic adrenal injuries are more frequently diagnosed. In usual, adrenal injury is associated with other abdominal and intrathoracic injuries. Isolated posttraumatic adrenal hematoma is a very rare entity with few cases been reported in the literature. We present here 2 rare cases of isolated posttraumatic adrenal hematoma managed in our Department of Urology.
| Case Reports | | |
Case 1
A 45-year-old male presented with a history of blunt trauma abdomen following road traffic accident. The patient complained of dull aching pain in right flank following the traumatic episode. The patient did not have any complaints of pain or swelling prior to trauma. Physical examination showed few abrasions in the right flank. Contrast enhanced CT (CECT) abdomen showed a nonenhancing right sided adrenal mass (2.3 cm × 3.4 cm) with an attenuation of 62 HU, compatible with traumatic adrenal hematoma [Figure 1]. The patient was managed conservatively with a resolution of the hematoma and was discharged after 5 days follow-up. | Figure 1: Computed tomography scan abdomen showing a space occupying lesion measuring 2 cm × 3 cm in size
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Case 2
A 27-year-old male presented with blunt trauma abdomen following road traffic accident. The patient presented with pain in the right flank, physical examination revealed bruise in the right flank. Ultrasonography abdomen revealed a suprarenal isoechogenic mass [Figure 2] and CECT abdomen showed a nonenhancing right sided adrenal mass (2 cm × 2.8cm) with attenuation of 68 HU [Figure 3] and [Figure 4]. The patient showed improvement both symptomatically (pain reduced) and radiologically (hematoma resolved) and was discharged after 3 days follow-up. | Figure 2: Ultrasonography of abdomen showing right sided suprarenal mass
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| Discussion | | |
Adrenal gland injuries are rare in blunt abdominal trauma and mostly are associated with either injury to other abdominal organs or intrathoracic injury.[1],[2] Burks et al.[3] in their study reported 1 case of isolated posttraumatic adrenal hematoma among 20 cases of blunt trauma abdomen. Injury to adrenal gland is incidentally diagnosed with computerized tomography the following trauma.[4] CECT scan remains the most accurate imaging modality and is useful to distinguish adrenal hematoma from an incidental adenoma.[2] In case of adrenal hematoma, CT scan abdomen shows an attenuation value of 50–90 HU (in our case the Hounsfield units were 62 and 68), whereas in cases of adrenal adenoma the attenuation value is <10 HU.[5] Although the innate limitation of the focused assessment with sonography for trauma (FAST) examination is in identifying specific organ injury, adrenal hematomas may be recognized by careful visualization of the hepatorenal and splenorenal fossa.[6] As unilateral adrenal injury tends to be clinically benign, management is generally conservative. Surgical intervention is performed for associated injury to other internal organs.[1],[7] Bilateral adrenal injury, when it occurs, can lead to life threatening adrenal insufficiency, and prompt corticosteroid replacement is required.[1],[8] The isolated adrenal hematoma, as seen in the cases presented here, is seen in only 4% of all adrenal injuries.[8]
| Conclusion | | |
Although most patients recover without any sequel after unilateral adrenal hemorrhage, in case of bilateral involvement of the adrenal gland, one has to be more cautious. Careful inspection of splenorenal and hepatorenal fossa during FAST examination in emergency ward and inspection of adrenals carefully on CT might be helpful in identifying patients with isolated posttraumatic adrenal hematoma which may be missed otherwise.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Mehrazin R, Derweesh IH, Kincade MC, Thomas AC, Gold R, Wake RW. Adrenal trauma: Elvis Presley Memorial Trauma Center experience. Urology 2007;70:851-5.  |
| 2. | Rana AI, Kenney PJ, Lockhart ME, McGwin G Jr, Morgan DE, Windham ST 3 rd, et al. Adrenal gland hematomas in trauma patients. Radiology 2004;230:669-75. |
| 3. | Burks DW, Mirvis SE, Shanmuganathan K. Acute adrenal injury after blunt abdominal trauma: CT findings. AJR Am J Roentgenol 1992;158:503-7. |
| 4. | Pinto A, Scaglione M, Pinto F, Gagliardi N, Romano L. Adrenal injuries: Spectrum of CT findings. Emerg Radiol 2003;10:30-3. |
| 5. | Boland GW, Lee MJ, Gazelle GS, Halpern EF, McNicholas MM, Mueller PR. Characterization of adrenal masses using unenhanced CT: An analysis of the CT literature. AJR Am J Roentgenol 1998;171:201-4. |
| 6. | Huang YC, Lee WJ, Lin HJ, Yang PJ. Isolated post-traumatic adrenal hematoma: Detection by bedside ultrasound in the emergency department. J Emerg Med 2012;42:e17-8. |
| 7. | Sinelnikov AO, Abujudeh HH, Chan D, Novelline RA. CT manifestations of adrenal trauma: Experience with 73 cases. Emerg Radiol 2007;13:313-8. |
| 8. | Chen KT, Lin TY, Foo NP, Lin HJ, Guo HR. Traumatic adrenal haematoma: A condition rarely recognised in the emergency department. Injury 2007;38:584-7. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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