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Wang TN, Padmanaban V, Bashian EJ, Davis HW, Kirsch MJ, Phay JE, Miller BS, Hackett CE, Dedhia PH. Clinical characteristics and outcomes of adrenal hemorrhage. Surgery 2024:S0039-6060(24)00133-8. [PMID: 38594100 DOI: 10.1016/j.surg.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Although uncommon, adrenal hemorrhage has multiple etiologies. Because clinical characteristics, management, and outcomes of patients with adrenal hemorrhage are inadequately described, we examined the underlying etiology, need for intervention, evolution of imaging characteristics, and adequacy of subsequent evaluation. METHODS We performed a retrospective review of patients diagnosed with adrenal hemorrhage (radiologist-confirmed density consistent with hemorrhage on computed tomography) from 2005 to 2021 at a university-based institution. Demographic characteristics, hemorrhage etiology, and subsequent follow-up were analyzed. RESULTS Of 193 adrenal hemorrhage patients, the mean age was 49.2 ± 18.3 years, and 35% were female. Clinical presentations included trauma (47%), abdominal or flank pain (28%), incidental findings on imaging acquired for other reasons (12%), postoperative complication (8%), or shock (3%). Hemorrhage outside of the gland was present in 62% of patients. Unilateral hemorrhage was more frequent (93%) than bilateral (7%). A total of 12% of patients had nodules, but only 70% of these were identified on initial imaging, and only 43% had hormonal evaluation. Of 7 patients who had adrenalectomy or biopsy, pathology was either benign (57%) or nonadrenal malignancy (43%). No adrenocortical carcinomas were identified. Follow-up imaging was performed in 56% of patients and revealed decreased, stable, resolved, or increased adrenal hemorrhage size in 39%, 19%, 30%, and 12% of patients, respectively. CONCLUSION Adrenal hemorrhage is secondary to multiple etiologies, most commonly trauma. In the setting of adrenal hemorrhage, many adrenal nodules were not identified on initial imaging. Only a minority of patients with nodules underwent "complete" biochemical evaluation. Follow-up imaging may improve the identification of underlying nodules needing hormonal evaluation.
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Affiliation(s)
- Theresa N Wang
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. https://www.twitter.com/turayza
| | - Vennila Padmanaban
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. https://www.twitter.com/vennilapadmanMD
| | - Elizabeth J Bashian
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Harold W Davis
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael J Kirsch
- Department of Surgery, University of Colorado, Aurora, CO. https://www.twitter.com/MichaelJKirsch
| | - John E Phay
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. https://www.twitter.com/JohnPhayMD
| | - Barbra S Miller
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. https://www.twitter.com/OSUEndoSurgBSM
| | | | - Priya H Dedhia
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH.
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Dogra P, Chinthapalli M, Sandooja R, Rahimi L, Iniguez-Ariza NM, Foster T, Bancos I. Adrenal Hemorrhage: A Comprehensive Analysis of a Heterogeneous Entity-Etiology, Presentation, Management, and Outcomes. Mayo Clin Proc 2024; 99:375-386. [PMID: 38432745 PMCID: PMC10917120 DOI: 10.1016/j.mayocp.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate the etiology, presentation, management, and outcomes of patients with adrenal hemorrhage (AH). PATIENTS AND METHODS Longitudinal study of consecutive adult patients with radiologically confirmed AH (January 1, 2017, through December 31, 2021). RESULTS Of the 363 patients with AH (median age, 62 years [interquartile range (IQR, 52-70 years]; 128 women [35%]), 338 (93%) had unilateral AH and 25 (7%) had bilateral AH. It was discovered incidentally in 152 patients (42%) and during the evaluation of trauma in 103 (28%), abdominal/back pain in 90 (25%), critical illness in 13 (4%), and symptoms of adrenal insufficiency in 5 (1%). Etiologies included postoperative complications in 150 patients (41%), trauma in 107 (30%), coagulopathy in 22 (6%), anticoagulant/antiplatelet therapy in 39 (11%), adrenal neoplasm in 22 (6%), and sepsis in 11, (3%). Overall, 165 patients (46%) were hospitalized, and no deaths occurred due to AH. Median (IQR) baseline AH size was 34 mm (24-40 mm) on the right and 29 mm (22-37 mm) on the left. Among 246 patients with follow-up imaging, AH resolution was complete in 155 (63%) and incomplete in 74 (30%) at a median of 15 months (IQR, 6-31 months). Patients with bilateral AH were more likely to have underlying coagulopathy (44% vs 3%) and to develop primary adrenal insufficiency (72% vs 0%) than those with unilateral AH (P<.001). CONCLUSION Often, AH presents as an incidental unilateral lesion with normal adrenal function, commonly attributed to postoperative complications or trauma. In contrast, bilateral AH is rare and typically linked to underlying coagulopathy, with primary adrenal insufficiency developing in most patients.
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Affiliation(s)
- Prerna Dogra
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison
| | - Mrunal Chinthapalli
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Rashi Sandooja
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Leili Rahimi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Nicole M Iniguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Medicine, American British Cowdray Medical Center, Mexico City, Mexico
| | | | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
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Chernyak V, Patlas MN, Menias CO, Soto JA, Kielar AZ, Rozenblit AM, Romano L, Katz DS. Traumatic and non-traumatic adrenal emergencies. Emerg Radiol 2015; 22:697-704. [PMID: 26482245 DOI: 10.1007/s10140-015-1357-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022]
Abstract
Multiple traumatic and non-traumatic adrenal emergencies are occasionally encountered during the cross-sectional imaging of emergency department patients. Traumatic adrenal hematomas are markers of severe polytrauma, and can be easily overlooked due to multiple concomitant injuries. Patients with non-traumatic adrenal emergencies usually present to an emergency department with a non-specific clinical picture. The detection and management of adrenal emergencies is based on cross-sectional imaging. Adrenal hemorrhage, adrenal infection, or rupture of adrenal neoplasm require immediate detection to avoid dire consequences. More often however, adrenal emergencies are detected incidentally in patients being investigated for non-specific acute abdominal pain. A high index of suspicion is required for the establishment of timely diagnosis and to avert potentially life-threatening complications. We describe cross-sectional imaging findings in patients with traumatic and non-traumatic adrenal hemorrhage, adrenal infarctions, adrenal infections, and complications of adrenal masses.
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Affiliation(s)
| | - Michael N Patlas
- Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada. .,Division of Emergency/Trauma Radiology, Department of Radiology, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON, Canada, L8L 2X2.
| | - Christine O Menias
- Department of Radiology, Mayo Clinic School of Medicine, Scottsdale, AZ, USA
| | - Jorge A Soto
- Department of Radiology, Boston University, Boston, MA, USA
| | - Ania Z Kielar
- Division of Abdominal and Pelvic Imaging, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Alla M Rozenblit
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, USA
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5
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Abstract
OBJECTIVE The objective of our study was to retrospectively define the incidence of adrenal hematoma on CT or MRI after nephrectomy. MATERIALS AND METHODS Between January 2008 and June 2009, 465 patients underwent nephrectomy at our institution. Of these, patients without both preoperative and postoperative abdominal CT or MR studies within 6 months of surgery (n = 83) and those with documented adrenalectomy at the time of radical nephrectomy (n = 33) were excluded. Thus, 349 patients (292 male, 57 female; mean age, 60.2 years; range, 2-88 years) were included in the study. Preoperative and postoperative CT or MR studies were reviewed by two radiologists in consensus for the presence or absence of adrenal hematoma. Diagnosis of adrenal hematoma was made by imaging findings and follow-up. The incidence of adrenal hematoma was calculated with a 95% CI. RESULTS Of the 349 patients (partial nephrectomy, n = 232; radical nephrectomy, n = 117), 19 patients developed adrenal hematoma after nephrectomy (partial nephrectomy, n = 12; radical nephrectomy, n = 7) with an incidence of 5.4% (95% CI, 3.1-7.8%). All adrenal hematomas were located on the side of nephrectomy (right adrenal gland, n = 8; left adrenal gland, n = 11). In nine patients, the adrenal hematoma appeared as a round or oval lesion on postoperative imaging with a mean size of 2.6 cm (range, 1.5-4.0 cm). In 10 patients, the adrenal hematoma appeared as diffuse enlargement of the adrenal gland on postoperative imaging with a mean thickness of 1.3 cm (range, 0.6-1.8 cm). CONCLUSION An adrenal hematoma was identified in 5.4% of patients on CT or MRI after nephrectomy. A new round or oval adrenal mass after nephrectomy should be differentiated from a metastasis.
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Arora S, Vargo S, Lupetin AR. Computed tomography appearance of spontaneous adrenal hemorrhage in a pheochromocytoma. Clin Imaging 2009; 33:314-7. [PMID: 19559356 DOI: 10.1016/j.clinimag.2008.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 12/01/2008] [Indexed: 11/25/2022]
Abstract
Pheochromocytomas are adrenal tumors that are diagnosed with time-consuming 24-h urine collection studies. Adrenal hemorrhage is a rare but serious complication of pheochromocytomas that has been reported in only about 50 cases [Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytomas. Review of a 50-year autopsy series. Mayo Clin Proc 1981;56:354-360]. We had a patient with a classic presentation of pheochromocytoma complicated with hypertensive crisis leading to spontaneous adrenal hemorrhage. We report the computed tomographic (CT) findings of ruptured pheochromocytoma that helped us in early detection and treatment of this life-threatening complication.
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Affiliation(s)
- Swati Arora
- Internal Medicine, Allegheny General Hospital, Drexel University, Pittsburgh, PA 15212, USA.
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Bilateral adrenal haemorrhage secondary to intra-abdominal sepsis: a case report. CASES JOURNAL 2009; 2:6894. [PMID: 19829879 PMCID: PMC2740141 DOI: 10.4076/1757-1626-2-6894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 04/17/2009] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Bilateral adrenal haemorrhage is a rare cause of adrenal failure. Clinical features are non-specific and therefore a high index of suspicion must be maintained in patients at risk. Predisposing factors include infection, malignancy and the post-operative state. CASE PRESENTATION We report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure. En-bloc splenectomy was performed to ensure an oncologic resection. The patient developed a purulent abdominal collection post-operatively and became septic with hypotension and pyrexia. This precipitated acute bilateral adrenal haemorrhage with consequent adrenal insufficiency. Clinical suspicion was confirmed by radiological findings and a co-syntropin test. Following drainage of the collection, antibiotic therapy and corticosteroid replacement, the patient made an excellent recovery. CONCLUSION This case highlights the importance of prompt diagnosis and treatment of adrenal failure. In their absence, this condition can rapidly lead to death of the patient.
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Goldman SM, Coelho RD, Freire Filho EDO, Abdala N, Szejnfeld D, Faria J, Judice PLP, Francisco VV, Kenney PJ, Szejnfeld J. Imaging procedures in adrenal pathology. ACTA ACUST UNITED AC 2004; 48:592-611. [PMID: 15761529 DOI: 10.1590/s0004-27302004000500004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Imaging plays a vital role in the evaluation of adrenal pathology. The most widely used modalities are computed tomography and magnetic resonance imaging. Alone or in conjunction with appropriate clinical and biochemical data, imaging can provide specific diagnoses that preclude the need for tissue sampling. This article reviews imaging features of normal and diseased adrenals, from both benign and malignant causes.
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Affiliation(s)
- Suzan M Goldman
- Genitourinary Imaging Service, Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Abstract
The radiologist can play a key role in diagnosis and management of many of the infectious, inflammatory, and neoplastic processes that affect patients after liver transplantation. Familiarity and skill with the full range of diagnostic and interventional tools are essential for radiologists dealing with transplant patients, even outside the medical centers where the transplantation takes place.
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Affiliation(s)
- Michael P Federle
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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10
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Friedewald SM, Molmenti EP, DeJong MR, Hamper UM. Vascular and nonvascular complications of liver transplants: sonographic evaluation and correlation with other imaging modalities and findings at surgery and pathology. Ultrasound Q 2003; 19:71-85; quiz 108-10. [PMID: 12973092 DOI: 10.1097/00013644-200306000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Liver transplantation is performed in adults and children to treat patients with irreversible liver damage when medical or other surgical treatment has failed. The most common indications for transplantation are cirrhosis secondary to fulminant acute hepatitis or chronic active hepatitis, sclerosing cholangitis, primary biliary cirrhosis, Budd-Chiari syndrome, inborn errors of metabolism, and unresectable but local hepatocellular carcinoma. This article reviews the sonographic findings in the preoperative evaluation of liver transplant recipients, briefly describes the surgical technique, and demonstrates normal postoperative findings in liver transplant recipients as well as complications associated with liver transplantation.
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Affiliation(s)
- Sarah M Friedewald
- Women's Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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11
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Abstract
The intent of this article is to provide a comprehensive review of MR imaging findings of cirrhosis and discusses clinical implications. Areas of focus include: (1) Morphologic changes of the liver in advanced cirrhosis and in early cirrhosis, (2) the frequency and imaging spectrum of intra- and extrahepatic changes in cirrhosis such as regenerative nodules, nodular liver surface, hepatic iron deposition, fibrosis, dilation of right inferior phrenic artery, gastrointestinal wall thickening, and portal hypertension, (3) serial MR findings of clinically progressive cirrhosis, (4) newly described MR sign of cirrhosis (an expanded gallbladder fossa sign), and (5) complications after liver transplantation. Understanding these MR features related to cirrhosis is helpful in clinical MR practice.
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Affiliation(s)
- Katsuyoshi Ito
- Department of Radiology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
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12
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Abstract
Hepatic transplantation has become the treatment of choice for advanced irreversible liver disease. More than 4,000 hepatic transplantations were performed in the United States in 1997 and more than 11,000 are awaiting transplantation. Graft endurance and overall patient survival has been steadily improving, and between 1992 and 1994, 82% of the patients who received a liver transplant survived for at least a year. Today, liver transplant patients have a five-year survival rate of approximately 75%. The improvement in survival can be attributed to better patient selection and preparation, advances in organ preservation, improved immunosuppressive therapy agents and refinement of surgical techniques. In this article, we will address the hepatic parenchyma and vascular structures that should be evaluated prior to and following liver transplantation, the range of expected anomalies and abnormalities, and the utility of each of the three main imaging modalities, namely ultrasonography, computed tomography and magnetic resonance imaging in this assessment.
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Affiliation(s)
- Hero K Hussain
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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14
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Abstract
There are many predisposing factors for neonatal adrenal haemorrhage but the causative factors are different in adults. Several cases of neonatal adrenal haemorrhage have been reported in association with renal vein thrombosis. This complication has not been documented in the adults. The presence of an adrenal mass in the setting of renal vein thrombosis should raise the possibility of adrenal haemorrhage even though this is extremely uncommon in adults.
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Affiliation(s)
- T K Loke
- Department of Radiology and Organ Imaging, United Christian Hospital, 130, Hip Wo Street, Kwun Tong, Kowloon, Hong Kong.
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Ito K, Siegelman ES, Stolpen AH, Mitchell DG. MR imaging of complications after liver transplantation. AJR Am J Roentgenol 2000; 175:1145-9. [PMID: 11000180 DOI: 10.2214/ajr.175.4.1751145] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- K Ito
- Department of Radiology, The Hospital of the University of Pennsylvania, 3400 Spruce St., 1st Floor, Silverstein, Philadelphia, PA 19104-4283, USA
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Kamishirado H, Inoue T, Fujito T, Akiya K, Ishiyama E, Sakuma M, Takayanagi K, Hayashi T, Morooka S. Idiopathic adrenal hemorrhage. Am J Med Sci 2000; 319:340-2. [PMID: 10830560 DOI: 10.1097/00000441-200005000-00013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of idiopathic adrenal hemorrhage is reported. A 76-year-old woman exhibited a left adrenal tumor, 3 cm in diameter, on abdominal computed tomography. The patient was receiving aspirin medication for atrial fibrillation. There was no evidence of increased adrenal hormones. The mass enlarged to 6 cm in diameter within 18 months, and malignancy was suspected. The mass was diagnosed as adrenal hematoma by operative findings.
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Affiliation(s)
- H Kamishirado
- Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan
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Kamishirado H, Teruo I, Fujito T, Akiya K, Ishiyama E, Sakuma M, Takayanagi K, Hayashi T, Morooka S. Idiopathic Adrenal Hemorrhage. Am J Med Sci 2000. [DOI: 10.1016/s0002-9629(15)40763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Leung DA, Pfammatter T, Marincek B. Diagnostic Imaging in Liver Transplantation. LIVER MALIGNANCIES 1999. [DOI: 10.1007/978-3-642-58641-5_28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Most adrenal masses are detected on CT scans, but only a minority has morphologic features that are characteristic of a specific histologic diagnosis. In patients with clinical or biochemical features of a hyperfunctioning adrenal syndrome, CT detection of a unilateral adrenal mass typically leads to surgical resection, although functional assessment of the mass with iodomethylnorcholesterol or MIBG scintigraphy sometimes is used to augment the CT findings. In patients with a nonhyperfunctioning adrenal mass, chemical shift MR and CT densitometry have begun to replace percutaneous adrenal biopsy or serial follow-up CT as methods to establish a specific diagnosis. In this article the authors review the clinical features and imaging findings of patients with known or suspected adrenal masses.
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Affiliation(s)
- M Korobkin
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, USA
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Cozzolino D, Peerzada J, Heaney JA. Adrenal insufficiency from bilateral adrenal hemorrhage after total knee replacement surgery. Urology 1997; 50:125-7. [PMID: 9218034 DOI: 10.1016/s0090-4295(97)00102-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Adrenal hemorrhage is a rare cause of adrenal insufficiency in adults. We examine the incidence, etiology, diagnosis, and therapy of adrenal insufficiency secondary to adrenal hemorrhage. This case illustrates the nonspecific presentation of adrenal insufficiency and the necessity of maintaining a high index of suspicion in a clinically confusing scenario.
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Affiliation(s)
- D Cozzolino
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA
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Kloos RT, Korobkin M, Thompson NW, Francis IR, Shapiro B, Gross MD. Incidentally discovered adrenal masses. Cancer Treat Res 1997; 89:263-92. [PMID: 9204197 DOI: 10.1007/978-1-4615-6355-6_13] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R T Kloos
- Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor 48109-0028, USA
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Hoeffel C, Legmann P, Luton JP, Chapuis Y, Fayet-Bonnin P. Spontaneous unilateral adrenal hemorrhage: computerized tomography and magnetic resonance imaging findings in 8 cases. J Urol 1995; 154:1647-51. [PMID: 7563311 DOI: 10.1016/s0022-5347(01)66738-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE We report and discuss the imaging features of 8 cases of spontaneous unilateral adrenal hematomas, a rare lesion. MATERIALS AND METHODS Computerized tomography (CT) was done in 8 cases, magnetic resonance imaging (MRI) in 5, and CT and MRI in 5. Imaging findings were reviewed and correlated with histological findings in all 8 cases. RESULTS MRI was the most accurate imaging modality and showed variable appearances. On pathological evaluation the hematomas were old and organized. No contrast enhancement was noted on CT or MRI. CONCLUSIONS One must not consider the diagnosis of spontaneous adrenal hematoma only as superimposed on a phechromocytoma or malignant lesion in the case of an incidentally discovered large adrenal mass with normal biological findings. MRI signs of adrenal hemorrhage and the failure of enhancement of such a mass should strongly suggest adrenal hematoma.
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Affiliation(s)
- C Hoeffel
- Department of Radiology A, Hôpital Cochin, Paris, France
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25
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Spontaneous Unilateral Adrenal Hemorrhage. J Urol 1995. [DOI: 10.1097/00005392-199511000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
CT is the imaging procedure of choice for detecting adrenal masses. In patients with biochemical evidence of an adrenal endocrine syndrome, CT can detect or exclude an adrenal mass in a high percentage of cases. Radionuclide scintigraphy is a useful adjunct in selected cases to characterize an adrenal mass as functional cortical (NP-59) or medullary (MIBG) tissue. In this article, the spectrum of adrenal imaging findings in patients with Cushing's syndrome, Conn's syndrome (primary aldosteronism), and pheochromocytoma is described and illustrated. In patients without an adrenal endocrine syndrome, an adrenal mass is detected on CT as an incidental finding or during a search for metastatic disease. Although pathognomonic findings of adrenal hemorrhage or myelolipoma are occasionally demonstrated, most adrenal masses have nonspecific morphological CT features. Differentiation of common benign adenomas from nonadenomatous adrenal masses, including metastases, remains an important clinical problem. This article reviews the current status, advantages, and limitations of the following methods to characterize an adrenal mass: (1) percutaneous adrenal biopsy, (2) NP-59 scintigraphy, (3) unenhanced CT densitometry, and (4) opposed-phase chemical shift MRI.
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Affiliation(s)
- M Korobkin
- University of Michigan Hospitals, Department of Radiology, Ann Arbor 48109-0030, USA
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27
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Holbert BL, Campbell WL, Skolnick ML. EVALUATION OF THE TRANSPLANTED LIVER AND POSTOPERATIVE COMPLICATIONS. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00305-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Abstract
Adrenal hemorrhage can occur in association with postoperative stress, trauma, myocardial infarction, infection, and chronic medical illness. Other risk factors for the development of spontaneous adrenal hemorrhage include a thromboembolic state and anticoagulation therapy, although it has rarely been observed following orthopedic surgery. The authors report the case of an otherwise healthy 61-year-old woman who died suddenly 9 days after bilateral total knee arthroplasty. The only abnormality found on postmortem examination was massive bilateral adrenal hemorrhage with destruction of nearly all adrenal tissue. Surgeons should be aware of this complication that, if recognized early, can be treated with steroid replacement.
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Affiliation(s)
- M D Ries
- Mary Imagene Bassett Hospital, Cooperstown, New York 13326
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29
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Szalados JE, Vukmir RB. Acute adrenal insufficiency resulting from adrenal hemorrhage as indicated by post-operative hypotension. Intensive Care Med 1994; 20:216-8. [PMID: 8014290 DOI: 10.1007/bf01704704] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We examined the incidence, diagnosis and therapy of acute adrenal insufficiency, secondary to adrenal hemorrhage. This insufficiency resulted in temperature irregularities. hemodynamic instability, and a large volume resuscitation requirement post-operatively. The case illustrates that a high level of suspicion should be maintained in a clinical scenario that mimics sepsis or myocardial insufficiency in the intensive care unit.
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30
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Shyn PB, Goldberg HI. Abdominal CT following liver transplantation. GASTROINTESTINAL RADIOLOGY 1992; 17:231-6. [PMID: 1612309 DOI: 10.1007/bf01888556] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Computed tomography (CT) is one of several imaging modalities employed in the evaluation of complications following orthotopic liver transplantation. Abdominal CT scans were performed in 92 (48%) of the first 190 liver transplant patients at our institution. These studies were retrospectively reviewed to determine the indications for CT in this population and to determine the incidences of the various CT findings. The major indication (70%) was detection of bile leakage, hemorrhage, or abscess. The role of CT was primarily to discover such abnormal fluid collections and guide their percutaneous drainage. This article describes a wide spectrum of common and uncommon findings following liver transplantation and illustrates their CT features.
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Affiliation(s)
- P B Shyn
- Department of Radiology, University of California-UCSF Medical Center, San Francisco 94143-0628
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