Advertisement

Adrenal Gland Injuries

  • Margherita Trinci
  • Federico Greco
  • Mariagrazia Ramunno
  • Diletta Cozzi
  • Valeria Saracco
  • Caterina Maria Trinci
  • Vittorio Miele
Chapter

Abstract

The adrenal gland injuries after major blunt (81.4%) or penetrating (18.6%) trauma are rarely reported especially as isolated lesions and their involvement is more frequent in patient with severe trauma, in association with other lesions. They have been associated with overall increased patient’s morbidity and mortality. In the Injury Severity Score (ISS) stratified analysis, the frequency of adrenal hematoma is increased with higher ISS categories.

Male sex is more affected than the female with a ratio of 76.4% men and 23.6% women. The predominance of male than female is particularly evident in the case of young male patients with penetrating wounds.

Most of the lesions are unilateral and right sided.

There are not specific clinical signs of adrenal lesion in polytrauma patients; only rarely, in the case of serious bilateral adrenal gland involvement, they may have an acute adrenal insufficiency syndrome that, if not ready-treated, causes a risk for the life of the patient.

Because of the rarity of this trauma nowadays there isn’t a consensus or algorithm for the treatment. The mortality rates of patients range from 7 to 32%.

Since the Computed Tomography (CT) is routinely used for the evaluation of polytraumatic patient, the diagnosis of adrenal trauma has become more frequent; before of using of CT the diagnosis was often random during surgery or postmortem autopsy.

The confidence with typical CT findings of adrenal trauma is fundamental for the radiologist to avoid misdiagnosis.

The management of adrenal trauma depends on many factors, including the presence and the severity of other injuries; therefore, it can be either surgical or nonsurgical.

The follow-up of the adrenal lesion can be performed both with CT and Magnetic Resonance Imaging (MRI), in same cases Ultrasound (US) has a role too.

Keywords

Trauma Trauma imaging Adrenal gland injury Injury Severity Score (ISS) Adrenal hemorrhage Associated injuries Diagnosis Treatment Retroperitoneal space Computed tomography CT Ultrasound US Contrast-enhanced ultrasound CEUS Magnetic resonance imaging MRI Follow-up Prognosis 

References

  1. 1.
    Elsayes KM, Mukundan G, Narra VR, et al. Adrenal masses: MR imaging features with pathologic correlation. Radiographics. 2004;24(Suppl 1):S73–86.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Sinelnikov AO, Abujudeh HH, Chan D, et al. CT manifestations of adrenal trauma: experience with 73 cases. Emerg Radiol. 2007;13:313–8.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    To’o KJ, Duddalwar VA. Imaging of traumatic adrenal injury. Emerg Radiol. 2012;19:499–503. doi: 10.1007/s10140-012-1063-y.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Stawicki SP, Hoey BA, Grossman MD. Adrenal gland trauma is associated with high injury severity and mortality. Curr Surg. 2003;60:431–6.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Burks DW, Mirvis SE, Shanmuganathan K. Acute adrenal injury after blunt abdominal trauma: CT findings. AJR Am J Roentgenol. 1992;158:503–7.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Pinto A, Scaglione M, Guidi G, et al. Role of multidetector row computed tomography in the assessment of adrenal gland injuries. Eur J Radiol. 2006;59:355–8.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Kahraman AS, Kahraman B, Ozdemir ZM et al (2016) Traumatic adrenal hematoma: clinical and imaging findings. ECR 2016. Type: Scientific Exhibit, Poster No: C-0193. doi: 10.1594/ecr2016/C-0193.
  8. 8.
    Lee MJ, Kim AG, Jang JE, et al. A case of traumatic bilateral adrenal hemorrhage mimicking bilateral adrenal adenomas. Yeungnam Univ J Med. 2012;29:35–7. doi: 10.1270/yujm.2012.29.1.35.CrossRefGoogle Scholar
  9. 9.
    Mahajan A, Rao V, Thakur M et al (2010) Adrenal injury after blunt abdominal trauma: correlation between CT findings and injury severity score ECR 2010, Poster No.: C-1176. Doi: 10.1594/ecr2010/C-1176.
  10. 10.
    Cardia G, Loverre G, Pomarico N, et al. Traumatic retroperitoneal lesions. Ann Ital Chir. 2000;71:457–67.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Gabalshehab L, Alagiri M. Traumatic adrenal injuries. J Urol. 2005;173:1330–1.CrossRefGoogle Scholar
  12. 12.
    Mehrazin R, Derweesh IH, Kincade MC, et al. Adrenal trauma: Elvis Presley Memorial Trauma Center experience. Urology. 2007;70:851–5.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Panda A, Kumar A, Gamanagatti S, et al. Are traumatic bilateral adrenal injuries associated with higher morbidity and mortality? A prospective observational study. J Trauma Manag Outcomes. 2015;9:6. doi: 10.1186/s13032-015-0026-1.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Sivit CJ, Ingram JD, Taylor GA, et al. Posttraumatic adrenal hemorrhage in children: CT findings in 34 patients. AJR Am J Roentgenol. 1992;58:1299–302.CrossRefGoogle Scholar
  15. 15.
    Gomez RG, McAninch JW, Carrol PR. Adrenal gland trauma: diagnosis and management. J Trauma. 1993;35:870–4.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Roupakias S, Papoutsakis M, Tsikopoulos G. Adrenal injuries following blunt abdominal trauma in children: report of two cases. Ulus Travma Acil Cerrahi Derg. 2012;18:171–4.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Woodruff S, Yeung M, Grodski S, et al. Adrenal injuries and incidentalomas in trauma patients at an urban trauma centre. J Curr Surg. 2012;2:123–9.Google Scholar
  18. 18.
    deRoux SJ, Prendergast NC. Adrenal lacerations in child abuse: a marker of severe trauma. Pediatr Surg Int. 2000;16:121–3.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Iuchtman M, Breitgand A. Traumatic adrenal hemorrhage in children: an indicator of visceral injury. Pediatr Surg Int. 2000;16:586–8.CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Shehab LG, Alagiri M. Traumatic adrenal injuries. J Urol. 2005;173:1330–1.CrossRefGoogle Scholar
  21. 21.
    Kim DG, Jung HS, et al. Endovascular treatment of a post-traumatic adrenal hemorrhage in a pediatric patient: a case report. J Korean Soc Radiol. 2016;75:508–11.CrossRefGoogle Scholar
  22. 22.
    Nimkin K, Teeger S, Wallach MT, et al. Adrenal hemorrhage in abused children: imaging and postmortem findings. AJR Am J Roentgenol. 1994;162:661–3.CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Sayit AT, Sayit E, Gunbey HP, et al. Imaging of unilateral adrenal hemorrhages in patients after blunt abdominal trauma: report of two cases. Chin J Traumatol. 2017;20:52–5. doi: 10.1016/j.cjtee.2016.05.002.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Liao CH, Lin J, Fu CY, et al. Adrenal gland trauma: is extravasation an absolute indication for intervention? World J Surg. 2015;39:1312–9. doi: 10.1007/s00268-015-2953-4.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Scaglione M. Emergency radiology: state of the art. Radiol Med. 2015;120:1–2. doi: 10.1007/s11547-014-0481-1.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sivit CJ, Taylor GA, Bulas DI, et al. Blunt trauma in children: significance of peritoneal fluid. Radiology. 1991;178:185–8.CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Miele V, Piccolo CL, Sessa B, et al. Comparison between MRI and CEUS in the follow-up of patients with blunt abdominal trauma managed conservatively. Radiol Med. 2016;121:27–37. doi: 10.1007/s11547-015-0578-1.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Sessa B, Trinci M, Ianniello S, et al. Blunt abdominal trauma: role of contrast-enhanced ultrasound in the detection and staging of abdominal traumatic lesions compared with US and CE-MDCT. Radiol Med. 2015;120:180–9. doi: 10.1007/s11547-014-0425-9.CrossRefGoogle Scholar
  29. 29.
    Pinto F, Valentino M, Romanini L, et al. The role of CEUS in the assessment of haemodinamically stable patients with blunt abdominal trauma. Radiol Med. 2015;120:3–11. doi: 10.1007/s11547-014-0455-3.CrossRefGoogle Scholar
  30. 30.
    Miele V, Di Giampietro I, Ianniello S, et al. Diagnostic imaging in pediatric polytrauma management. Radiol Med. 2015;120:33–49. doi: 10.1007/s11547-014-0469-x.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Menichini G, Sessa B, Trinci M, et al. Accuracy of contrast-enhanced ultrasound (CEUS) in the identification and characterization of traumatic solid organ lesions in children: a retrospective comparison with baseline-US and CE-MDCT. Radiol Med. 2015;120:989–1001. doi: 10.1007/s11547-015-0535-z.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Miele V, Piccolo CL, Trinci M, et al. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med. 2016;121:409–30. doi: 10.1007/s11547-016-0637-2.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Di Giacomo V, Trinci M, Van der Byl G, et al. Ultrasound in newborns and children suffering from nontraumatic acute abdominal pain: imaging with clinical and surgical correlation. J Ultrasound. 2015;18:385–93. doi: 10.1007/s40477-014-0087-4.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Trinci M, Trinci CM, Galluzzo M, et al. Neonatal adrenal hemorrhage. In: Miele V, Trinci M, editors. Imaging non-traumatic abdominal emergencies in pediatric patients. Switzerland: Springer International Publishing; 2016. p. 181–92.CrossRefGoogle Scholar
  35. 35.
    Jordan E, Poder L, Courtier J, et al. Imaging of nontraumatic adrenal hemorrhage. AJR Am J Roentgenol. 2012;199:W91–8. doi: 10.2214/AJR.11.7973.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Wedmid A, Palese M. Diagnosis and treatment of the adrenal cyst. Curr Urol Rep. 2010;11:44–50. doi: 10.1007/s11934-009-008-1.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Cagini L, Gravante S, Malaspina CM, et al. Contrast enhanced ultrasound (CEUS) in blunt abdominal trauma. Crit Ultrasound J. 2013;15:5. doi: 10.1186/2036-7902-5-S1-S9.CrossRefGoogle Scholar
  38. 38.
    Valentino M, Serra C, Pavlica P, et al. Contrast-enhanced ultrasound for blunt abdominal trauma. Semin Ultrasound CT MR. 2007;28:130–40.CrossRefGoogle Scholar
  39. 39.
    Miele V, Piccolo CL, Galluzzo M, et al. Contrast enhanced ultrasound (CEUS) in blunt abdominal trauma. Br J Radiol. 2016;89(1061):20150823. doi: 10.1259/bjr.20150823.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Cosgrove D. Ultrasound contrast agent: an overview. Eur J Radiol. 2006;60:324–30.CrossRefPubMedCentralGoogle Scholar
  41. 41.
    Pinto F, Miele V, Scaglione M, et al. The use of contrast-enhanced ultrasound in blunt abdominal trauma: advantages and limitations. Acta Radiol. 2014;55:776–84. doi: 10.1177/0284185113505517. Epub 2013 Sep 23CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Marti JL, Millet J, Sosa JA, et al. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012;36:75–82. doi: 10.1007/s00268-011-1338-6.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Rhea JT, Garza DH, Novelline RA. Controversies in emergency radiology CT versus ultrasound in the evaluation of blunt abdominal trauma. Emerg Radiol. 2004;10:289–95.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Pinto A, Scaglione M, Pinto F, et al. Adrenal injuries: spectrum of CT findings. Emerg Radiol. 2003;10:30–3.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Scialpi M, Palumbo B, Pierotti L, et al. Detection and characterization of focal liver lesions by split-bolus multidetector-row CT: diagnostic accuracy and radiation dose in oncologic patients. Anticancer Res. 2014;34:4335–44.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Lee YS, Jeong JJ, Nam KH, et al. Adrenal injury following blunt abdominal trauma. World J Surg. 2010;34:1971–4. doi: 10.1007/s00268-010-0537-x.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Daly KP, Ho CP, Persson DL, Gay SB. Traumatic retroperitoneal injuries: review of multidetector CT findings. Radiographics. 2008;28:1571–90. doi: 10.1148/rg.286075141.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Sacerdote MG, Johnson PT, Fishman EK. CT of the adrenal gland: the many faces of adrenal hemorrhage. Emerg Radiol. 2012;19:53–60. doi: 10.1007/s10140-011-0989-9.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Ikeda O, Urata J, Araki Y, et al. Acute adrenal hemorrhage after blunt trauma. Abdom Imaging. 2007;32:248–52.CrossRefPubMedCentralGoogle Scholar
  50. 50.
    Dunnick NR, Korobkin M. Imaging of adrenal Incidentalomas: current status. AJR Am J Roentgenol. 2002;179:559–68.CrossRefPubMedCentralGoogle Scholar
  51. 51.
    Pinto A, Brunese L, Pinto F, et al. The concept of error and malpractice in radiology. Semin Ultrasound CT MR. 2012;33:275–9. doi: 10.1053/j.sult.2012.01.009.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Elsayes KM, Mukundan G, Narra VR, et al. Adrenal masses: MR imaging features with pathologic correlation. Radiographics. 2004;1:S73–86.CrossRefGoogle Scholar
  53. 53.
    Schultz CL, Haaga JR, Fletcher BD, et al. Magnetic resonance imaging of the adrenal glands: a comparison with computer tomography. AJR Am J Roentgenol. 1984;143:1235–40.CrossRefPubMedCentralGoogle Scholar
  54. 54.
    Rammelt S, Mucha D, Amlang M, et al. Bilateral adrenal hemorrhage in blunt abdominal trauma. J Trauma. 2000;48:332–5.CrossRefPubMedCentralGoogle Scholar
  55. 55.
    Igwilo OC, Sulkowski RJ, Shah MR, et al. Embolization of traumatic adrenal hemorrhage. J Trauma. 1999;47:1153–5.CrossRefPubMedCentralGoogle Scholar
  56. 56.
    Roupakias S, Papoutsakis M, Mitsakou P. Blunt adrenal gland trauma in the pediatric population. Asian J Surg. 2011;34:10310. doi: 10.1016/j.asjsur.2011.08.003.CrossRefGoogle Scholar
  57. 57.
    Udobi KF, Childs EW. Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma. 2001;51:597–600.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Ikekpeazzu N, Bonadies JA, Sreenivas VI. Acute bilateral adrenal hemorrhage secondary to rough truck ride. J Emerg Med. 1996;14:15–8.CrossRefPubMedCentralGoogle Scholar
  59. 59.
    Castaldo ET, Guillamondegui OD, Greco JA, et al. Are adrenal injuries predictive of adrenal insufficiency in patients sustaining blunt trauma? Am Surg. 2008;74:262–6.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Francque SM, Schwagten VM, Ysebaert DK, et al. Bilateral adrenal haemorrhage and acute adrenal insufficiency in a blunt abdominal trauma: a case-report and literature review. J Emerg Med. 2004;11:164–7.Google Scholar
  61. 61.
    Baccot S, Tiffet O, Bonnot P, et al. Bilateral post-traumatic adrenal hemorrhage. Report of a case with acute adrenal insufficiency. Ann Chir. 2000;125:273–5.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Margherita Trinci
    • 1
  • Federico Greco
    • 1
  • Mariagrazia Ramunno
    • 1
  • Diletta Cozzi
    • 2
  • Valeria Saracco
    • 1
  • Caterina Maria Trinci
    • 1
  • Vittorio Miele
    • 2
  1. 1.Department of Emergency RadiologyS. Camillo HospitalRomeItaly
  2. 2.Department of RadiologyCareggi University HospitalFlorenceItaly

Personalised recommendations