adrenal gland trauma

Adrenal gland trauma most commonly results from blunt force trauma.


Adrenal gland trauma is present on 1-2% of CT imaging in blunt trauma although the occurrence is thought to be much higher as injury has been demonstrated at 28% in one autopsy series .

The right adrenal gland is more commonly affected than the left with a ratio of 3-4:1 .


Adrenal hemorrhage is the most common injury to the adrenal gland and is thought to be a result of direct compression or increased venous pressures from IVC compression. Laceration of the adrenal gland is less common .


Isolated adrenal gland trauma is uncommon (<5% of all adrenal trauma ) and associated injuries include :

Adrenal gland traumatic hemorrhage may also present with :

Radiographic features

  • hematoma presents as a well-defined nodular mass, within either the body or the limb with a density of 50-80 HU
  • diffuse enlargement or replacement of the adrenal gland with less well-defined borders can also be seen and most often relates to laceration
  • periadrenal fat stranding is often present
  • T1: hematoma is isointense to muscle, liver, renal cortex
  • T2: hematoma is very hyperintense; hyperintense fat stranding

Treatment and prognosis

Adrenal gland trauma is important to recognize as mortality is twice as high in blunt trauma patients with adrenal gland injury than without . Management is often conservative but may vary depending on hemodynamic stability and the presence of active bleeding .

Complications include :

  • acute adrenal insufficiency (if bilateral)
  • delayed hemorrhage
  • calcification
  • pseudocyst formation
  • thrombus from IVC compression (rare)

Differential diagnosis

Differentials to consider include:

Practical points

The presence of a discrete adrenal mass in the context of blunt trauma without injury to other abdominal organs or CT features of injury warrants follow-up investigation .

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