Diagnostic Ultrasound - Abdomen and Pelvis

Adrenal Hemorrhage
Diagnoses: Adrenal Gland
IMAGING
• May be unilateral or bilateral
• Variable appearance depending on age of hemorrhage
• US: Nonspecific, avascular hypoechoic, hyperechoic or
heterogeneous lesion
• CT/MR: Can better characterize hemorrhagic contents of
lesion, increasing specificity
TOP DIFFERENTIAL DIAGNOSES
• Adrenal adenoma
• Pheochromocytoma
• Myelolipoma
• Primary adrenal or metastatic tumors
• Adjacent neoplasm
• Adrenal lymphoma
PATHOLOGY
• Nontraumatic pathogenesis: Vascular dam of abundant
arterial supply and limited venous drainage
KEY FACTS
CLINICAL ISSUES
• Relatively uncommon condition but potentially
catastrophic event
○ Bilateral in 15% of individuals who die of shock
○ Can result in adrenal insufficiency
• More common in neonates than children & adults
○ Most common cause of adrenal mass in infancy
• Occurs secondary to traumatic (more common) &
nontraumatic causes
○ Traumatic hemorrhage: Blunt abdominal trauma
– 25% of patients with blunt abdominal trauma have
adrenal hemorrhage
– Unilateral in 80% of cases: Right (85%), left (15%)
○ Nontraumatic hemorrhage (often bilateral)
– Stress, bleeding disorders, adrenal tumors
– Neonatal stress (birth asphyxia), idiopathic
– Meningococcal septicemia (Waterhouse-Friderichsen
syndrome)
(Left) Longitudinal color
Doppler ultrasound shows an
avascular, heterogeneously
hyperechoic, right suprarenal
lesion . Note right kidney
ſt. (Right) Longitudinal color
Doppler ultrasound shows a
heterogeneous, avascular
right suprarenal lesion with a
hypoechoic center and
irregular echogenic
components along the
periphery st. Note right
kidney ſt.
(Left) Longitudinal color
Doppler ultrasound shows a
well-defined hypoechoic lesion
in the right adrenal gland with
no vascular flow . (Right)
Axial NECT in the same patient
demonstrates a well-defined,
hyperdense, right adrenal
hematoma . Note skin
staples ſt in the abdominal
wall from recent liver
transplantation as well as
ascites st.
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