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.
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