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Published in: Abdominal Radiology 3/2021

01-03-2021 | Computed Tomography | Review

Can we differentiate neoplastic and non-neoplastic spontaneous adrenal bleeding? Imaging findings with radiopathologic correlation

Authors: Ali Devrim Karaosmanoglu, Aycan Uysal, Sevtap Arslan, Cenk Sokmensuer, Can Berk Leblebici, Deniz Akata, Mustafa Nasuh Ozmen, Musturay Karcaaltincaba

Published in: Abdominal Radiology | Issue 3/2021

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Abstract

Spontaneous adrenal bleeding is a rare clinical event with non-specific clinical features. Life-threatening bleeding in the adrenal glands may be promptly diagnosed with imaging. Computed tomography (CT) is generally the first imaging modality to be used in these patients. However, in the acute phase of bleeding, it may be difficult to detect the underlying mass from the large hematoma. In these patients, additional imaging studies such as magnetic resonance imaging or positron emission tomography/CT may be utilized to rule out a neoplastic mass as the source of bleeding. In patients where an underlying neoplastic mass could not be identified at the time of initial diagnosis, follow-up imaging may be helpful after the acute phase subsides.
Literature
1.
go back to reference Baccot S, Tiffet O, Bonnot P, Perrot L, Cuilleret J. [Bilateral post-traumatic adrenal hemorrhage. Report of a case with acute adrenal insufficiency]. Ann Chir. 2000;125(3):273–5. Baccot S, Tiffet O, Bonnot P, Perrot L, Cuilleret J. [Bilateral post-traumatic adrenal hemorrhage. Report of a case with acute adrenal insufficiency]. Ann Chir. 2000;125(3):273–5.
2.
go back to reference Mehrazin R, Derweesh IH, Kincade MC, Thomas AC, Gold R, Wake RW. Adrenal trauma: Elvis Presley Memorial Trauma Center experience. Urology. 2007;70(5):851-5.CrossRef Mehrazin R, Derweesh IH, Kincade MC, Thomas AC, Gold R, Wake RW. Adrenal trauma: Elvis Presley Memorial Trauma Center experience. Urology. 2007;70(5):851-5.CrossRef
3.
go back to reference Jordan E, Poder L, Courtier J, Sai V, Jung A, Coakley FV. Imaging of nontraumatic adrenal hemorrhage. AJR Am J Roentgenol. 2012;199(1):W91-8.CrossRef Jordan E, Poder L, Courtier J, Sai V, Jung A, Coakley FV. Imaging of nontraumatic adrenal hemorrhage. AJR Am J Roentgenol. 2012;199(1):W91-8.CrossRef
4.
go back to reference Simon DR, Palese MA. Clinical update on the management of adrenal hemorrhage. Curr Urol Rep. 2009;10(1):78-83.CrossRef Simon DR, Palese MA. Clinical update on the management of adrenal hemorrhage. Curr Urol Rep. 2009;10(1):78-83.CrossRef
5.
go back to reference Catalano O. Retroperitoneal hemorrhage due to a ruptured adrenal myelolipoma. A case report. Acta Radiol. 1996;37(5):688-90.PubMed Catalano O. Retroperitoneal hemorrhage due to a ruptured adrenal myelolipoma. A case report. Acta Radiol. 1996;37(5):688-90.PubMed
6.
go back to reference Rao RH, Vagnucci AH, Amico JA. Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann Intern Med. 1989;110(3):227-35.CrossRef Rao RH, Vagnucci AH, Amico JA. Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann Intern Med. 1989;110(3):227-35.CrossRef
7.
go back to reference Kovacs KA, Lam YM, Pater JL. Bilateral massive adrenal hemorrhage. Assessment of putative risk factors by the case-control method. Medicine (Baltimore). 2001;80(1):45–53. Kovacs KA, Lam YM, Pater JL. Bilateral massive adrenal hemorrhage. Assessment of putative risk factors by the case-control method. Medicine (Baltimore). 2001;80(1):45–53.
8.
go back to reference Hinrichs CR, Singer A, Maldjian P, Abu-Judeh H, Dadarwala A. Inferior vena cava thrombosis: a mechanism of posttraumatic adrenal hemorrhage. AJR Am J Roentgenol. 2001;177(2):357-8.CrossRef Hinrichs CR, Singer A, Maldjian P, Abu-Judeh H, Dadarwala A. Inferior vena cava thrombosis: a mechanism of posttraumatic adrenal hemorrhage. AJR Am J Roentgenol. 2001;177(2):357-8.CrossRef
9.
go back to reference Udobi KF, Childs EW. Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma. 2001;51(3):597-600.PubMed Udobi KF, Childs EW. Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma. 2001;51(3):597-600.PubMed
10.
go back to reference Dong A, Cui Y, Wang Y, Zuo C, Bai Y. (18)F-FDG PET/CT of adrenal lesions. AJR American journal of roentgenology. 2014;203(2):245-52.CrossRef Dong A, Cui Y, Wang Y, Zuo C, Bai Y. (18)F-FDG PET/CT of adrenal lesions. AJR American journal of roentgenology. 2014;203(2):245-52.CrossRef
11.
go back to reference Singh J, Dalal P, Bhalla K, Rattan KN. Neonatal Adrenal Hemorrhage presenting as Prolonged Hyperbilirubinemia. J Neonatal Surg. 2016;5(2):22.CrossRef Singh J, Dalal P, Bhalla K, Rattan KN. Neonatal Adrenal Hemorrhage presenting as Prolonged Hyperbilirubinemia. J Neonatal Surg. 2016;5(2):22.CrossRef
12.
go back to reference Wang CH, Chen SJ, Yang LY, Tang RB. Neonatal adrenal hemorrhage presenting as a multiloculated cystic mass. J Chin Med Assoc. 2008;71(9):481-4.CrossRef Wang CH, Chen SJ, Yang LY, Tang RB. Neonatal adrenal hemorrhage presenting as a multiloculated cystic mass. J Chin Med Assoc. 2008;71(9):481-4.CrossRef
13.
go back to reference Sargar KM, Khanna G, Hulett Bowling R. Imaging of Nonmalignant Adrenal Lesions in Children. Radiographics. 2017;37(6):1648-64.CrossRef Sargar KM, Khanna G, Hulett Bowling R. Imaging of Nonmalignant Adrenal Lesions in Children. Radiographics. 2017;37(6):1648-64.CrossRef
14.
go back to reference Toti MS, Ghirri P, Bartoli A, Caputo C, Laudani E, Masoni F, et al. Adrenal hemorrhage in newborn: how, when and why- from case report to literature review. Ital J Pediatr. 2019;45(1):58.CrossRef Toti MS, Ghirri P, Bartoli A, Caputo C, Laudani E, Masoni F, et al. Adrenal hemorrhage in newborn: how, when and why- from case report to literature review. Ital J Pediatr. 2019;45(1):58.CrossRef
15.
go back to reference Kurtz LE, Yang S. Bilateral adrenal hemorrhage associated with heparin induced thrombocytopenia. Am J Hematol. 2007;82(6):493-4.CrossRef Kurtz LE, Yang S. Bilateral adrenal hemorrhage associated with heparin induced thrombocytopenia. Am J Hematol. 2007;82(6):493-4.CrossRef
16.
go back to reference Limper M, Scire CA, Talarico R, Amoura Z, Avcin T, Basile M, et al. Antiphospholipid syndrome: state of the art on clinical practice guidelines. RMD Open. 2018;4(Suppl 1):e000785.CrossRef Limper M, Scire CA, Talarico R, Amoura Z, Avcin T, Basile M, et al. Antiphospholipid syndrome: state of the art on clinical practice guidelines. RMD Open. 2018;4(Suppl 1):e000785.CrossRef
17.
go back to reference Espinosa G, Santos E, Cervera R, Piette JC, de la Red G, Gil V, et al. Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine (Baltimore). 2003;82(2):106-18.CrossRef Espinosa G, Santos E, Cervera R, Piette JC, de la Red G, Gil V, et al. Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine (Baltimore). 2003;82(2):106-18.CrossRef
18.
go back to reference Christoforides C, Petrou A, Loizou M. Idiopathic unilateral adrenal haemorrhage and adrenal mass: a case report and review of the literature. Case Rep Surg. 2013;2013:567186.PubMedPubMedCentral Christoforides C, Petrou A, Loizou M. Idiopathic unilateral adrenal haemorrhage and adrenal mass: a case report and review of the literature. Case Rep Surg. 2013;2013:567186.PubMedPubMedCentral
19.
go back to reference Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, et al. Imaging features of adrenal masses. Insights into imaging. 2019;10(1):1.CrossRef Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, et al. Imaging features of adrenal masses. Insights into imaging. 2019;10(1):1.CrossRef
20.
go back to reference Elaini AB, Shetty SK, Chapman VM, Sahani DV, Boland GW, Sweeney AT, et al. Improved Detection and Characterization of Adrenal Disease with PET-CT. Radiographics : a review publication of the Radiological Society of North America, Inc. 2007;27(3):755–67. Elaini AB, Shetty SK, Chapman VM, Sahani DV, Boland GW, Sweeney AT, et al. Improved Detection and Characterization of Adrenal Disease with PET-CT. Radiographics : a review publication of the Radiological Society of North America, Inc. 2007;27(3):755–67.
21.
go back to reference Sturgeon C, Kebebew E. Laparoscopic adrenalectomy for malignancy. Surg Clin North Am. 2004;84(3):755-74.CrossRef Sturgeon C, Kebebew E. Laparoscopic adrenalectomy for malignancy. Surg Clin North Am. 2004;84(3):755-74.CrossRef
22.
go back to reference Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, et al. Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer. 2005;12(3):667-80.CrossRef Schteingart DE, Doherty GM, Gauger PG, Giordano TJ, Hammer GD, Korobkin M, et al. Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr Relat Cancer. 2005;12(3):667-80.CrossRef
23.
go back to reference Polistina FA, Farruggio A, Gasparin P, Pasquale S, Frego M. Spontaneously metachronous ruptures of adrenocortical carcinoma and its contralateral adrenal metastasis. Int Cancer Conf J. 2016;5(2):90-7.CrossRef Polistina FA, Farruggio A, Gasparin P, Pasquale S, Frego M. Spontaneously metachronous ruptures of adrenocortical carcinoma and its contralateral adrenal metastasis. Int Cancer Conf J. 2016;5(2):90-7.CrossRef
24.
go back to reference Ronchi CL, Kroiss M, Sbiera S, Deutschbein T, Fassnacht M. EJE prize 2014: current and evolving treatment options in adrenocortical carcinoma: where do we stand and where do we want to go? Eur J Endocrinol. 2014;171(1):R1-R11.CrossRef Ronchi CL, Kroiss M, Sbiera S, Deutschbein T, Fassnacht M. EJE prize 2014: current and evolving treatment options in adrenocortical carcinoma: where do we stand and where do we want to go? Eur J Endocrinol. 2014;171(1):R1-R11.CrossRef
25.
go back to reference Kawashima A, Sandler CM, Ernst RD, Takahashi N, Roubidoux MA, Goldman SM, et al. Imaging of Nontraumatic Hemorrhage of the Adrenal Gland. Radiographics : a review publication of the Radiological Society of North America, Inc. 1999;19(4):949–63. Kawashima A, Sandler CM, Ernst RD, Takahashi N, Roubidoux MA, Goldman SM, et al. Imaging of Nontraumatic Hemorrhage of the Adrenal Gland. Radiographics : a review publication of the Radiological Society of North America, Inc. 1999;19(4):949–63.
26.
go back to reference Leung K, Stamm M, Raja A, Low G. Pheochromocytoma: The Range of Appearances on Ultrasound, CT, MRI, and Functional Imaging. American Journal of Roentgenology. 2013;200(2):370-8.CrossRef Leung K, Stamm M, Raja A, Low G. Pheochromocytoma: The Range of Appearances on Ultrasound, CT, MRI, and Functional Imaging. American Journal of Roentgenology. 2013;200(2):370-8.CrossRef
27.
go back to reference Hanna JS, Spencer PJ, Savopoulou C, Kwasnik E, Askari R. Spontaneous adrenal pheochromocytoma rupture complicated by intraperitoneal hemorrhage and shock. World J Emerg Surg. 2011;6(1):27.CrossRef Hanna JS, Spencer PJ, Savopoulou C, Kwasnik E, Askari R. Spontaneous adrenal pheochromocytoma rupture complicated by intraperitoneal hemorrhage and shock. World J Emerg Surg. 2011;6(1):27.CrossRef
28.
go back to reference Marti JL, Millet J, Sosa JA, Roman SA, Carling T, Udelsman R. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012;36(1):75-82.CrossRef Marti JL, Millet J, Sosa JA, Roman SA, Carling T, Udelsman R. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012;36(1):75-82.CrossRef
29.
go back to reference Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM. Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics. 2003;23(1):29-43.CrossRef Rha SE, Byun JY, Jung SE, Chun HJ, Lee HG, Lee JM. Neurogenic tumors in the abdomen: tumor types and imaging characteristics. Radiographics. 2003;23(1):29-43.CrossRef
30.
go back to reference Papaioannou G, McHugh K. Neuroblastoma in childhood: review and radiological findings. Cancer Imaging. 2005;5:116-27.CrossRef Papaioannou G, McHugh K. Neuroblastoma in childhood: review and radiological findings. Cancer Imaging. 2005;5:116-27.CrossRef
31.
go back to reference Honda S, Miyagi H, Minato M, Kubota KC, Okada T. Hemorrhagic shock due to spontaneous rupture of adrenal neuroblastoma in an infant: a rare case and review of the literature. J Pediatr Hematol Oncol. 2012;34(8):635-7.CrossRef Honda S, Miyagi H, Minato M, Kubota KC, Okada T. Hemorrhagic shock due to spontaneous rupture of adrenal neuroblastoma in an infant: a rare case and review of the literature. J Pediatr Hematol Oncol. 2012;34(8):635-7.CrossRef
32.
go back to reference Elsayes KM, Mukundan G, Narra VR, James S. Lewis J, Shirkhoda A, Farooki A, et al. Adrenal Masses: MR Imaging Features with Pathologic Correlation. Radiographics : a review publication of the Radiological Society of North America, Inc. 2004;24(suppl_1):S73-S86. Elsayes KM, Mukundan G, Narra VR, James S. Lewis J, Shirkhoda A, Farooki A, et al. Adrenal Masses: MR Imaging Features with Pathologic Correlation. Radiographics : a review publication of the Radiological Society of North America, Inc. 2004;24(suppl_1):S73-S86.
33.
go back to reference Yang PW, Wang WY, Yang CH, Chou CC, Yen DH, Chou J. Treatment of massive retroperitoneal hemorrhage from adrenal metastasis of hepatoma. J Chin Med Assoc. 2007;70(3):126-31.CrossRef Yang PW, Wang WY, Yang CH, Chou CC, Yen DH, Chou J. Treatment of massive retroperitoneal hemorrhage from adrenal metastasis of hepatoma. J Chin Med Assoc. 2007;70(3):126-31.CrossRef
34.
go back to reference Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH. Adrenal imaging: a comprehensive review. Radiologic clinics of North America. 2012;50(2):219–43, v. Taffel M, Haji-Momenian S, Nikolaidis P, Miller FH. Adrenal imaging: a comprehensive review. Radiologic clinics of North America. 2012;50(2):219–43, v.
35.
go back to reference Paling MR, Williamson BR. Adrenal involvement in non-Hodgkin lymphoma. AJR American journal of roentgenology. 1983;141(2):303-5.CrossRef Paling MR, Williamson BR. Adrenal involvement in non-Hodgkin lymphoma. AJR American journal of roentgenology. 1983;141(2):303-5.CrossRef
36.
go back to reference Kartsios C, Kaloyannidis P, Yannaki E, Iordanidis P, Penopoulos V, Sakellari I, et al. Spontaneous adrenal haemorrhage as a manifestation of isolated relapse of non-Hodgkin's lymphoma. Acta Haematol. 2003;110(4):197-9.CrossRef Kartsios C, Kaloyannidis P, Yannaki E, Iordanidis P, Penopoulos V, Sakellari I, et al. Spontaneous adrenal haemorrhage as a manifestation of isolated relapse of non-Hodgkin's lymphoma. Acta Haematol. 2003;110(4):197-9.CrossRef
37.
go back to reference Karaosmanoglu AD, Uysal A, Onur MR, Hahn PF, Ayhan AS, Ozmen MN, et al. Primary lymphomas of the intraabdominal solid organs and the gastrointestinal tract: spectrum of imaging findings with histopathological confirmation. Abdominal radiology (New York). 2019;44(9):2988-3005.CrossRef Karaosmanoglu AD, Uysal A, Onur MR, Hahn PF, Ayhan AS, Ozmen MN, et al. Primary lymphomas of the intraabdominal solid organs and the gastrointestinal tract: spectrum of imaging findings with histopathological confirmation. Abdominal radiology (New York). 2019;44(9):2988-3005.CrossRef
38.
go back to reference Zhou L, Peng W, Wang C, Liu X, Shen Y, Zhou K. Primary adrenal lymphoma: radiological; pathological, clinical correlation. European journal of radiology. 2012;81(3):401-5.CrossRef Zhou L, Peng W, Wang C, Liu X, Shen Y, Zhou K. Primary adrenal lymphoma: radiological; pathological, clinical correlation. European journal of radiology. 2012;81(3):401-5.CrossRef
39.
go back to reference Liu HP, Chang WY, Chien ST, Hsu CW, Wu YC, Kung WC, et al. Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature. BMC Surg. 2017;17(1):74.CrossRef Liu HP, Chang WY, Chien ST, Hsu CW, Wu YC, Kung WC, et al. Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature. BMC Surg. 2017;17(1):74.CrossRef
40.
go back to reference Amano T, Takemae K, Niikura S, Kouno M, Amano M. Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma. Int J Urol. 1999;6(11):585-8.CrossRef Amano T, Takemae K, Niikura S, Kouno M, Amano M. Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma. Int J Urol. 1999;6(11):585-8.CrossRef
41.
go back to reference Schieda N, Siegelman ES. Update on CT and MRI of Adrenal Nodules. American Journal of Roentgenology. 2017;208(6):1206-17.CrossRef Schieda N, Siegelman ES. Update on CT and MRI of Adrenal Nodules. American Journal of Roentgenology. 2017;208(6):1206-17.CrossRef
42.
go back to reference Cerwenka H, Karaic R, Pfeifer J, Wolf G. Laceration of a benign adrenal adenoma mimicking a splenic rupture. Langenbecks Arch Surg. 1998;383(3-4):249-51.CrossRef Cerwenka H, Karaic R, Pfeifer J, Wolf G. Laceration of a benign adrenal adenoma mimicking a splenic rupture. Langenbecks Arch Surg. 1998;383(3-4):249-51.CrossRef
43.
go back to reference Denzinger S, Burger M, Hartmann A, Hofstaedter F, Wieland WF, Ganzer R. Spontaneous rupture of a benign giant adrenal adenoma. APMIS. 2007;115(4):381-4.CrossRef Denzinger S, Burger M, Hartmann A, Hofstaedter F, Wieland WF, Ganzer R. Spontaneous rupture of a benign giant adrenal adenoma. APMIS. 2007;115(4):381-4.CrossRef
Metadata
Title
Can we differentiate neoplastic and non-neoplastic spontaneous adrenal bleeding? Imaging findings with radiopathologic correlation
Authors
Ali Devrim Karaosmanoglu
Aycan Uysal
Sevtap Arslan
Cenk Sokmensuer
Can Berk Leblebici
Deniz Akata
Mustafa Nasuh Ozmen
Musturay Karcaaltincaba
Publication date
01-03-2021
Publisher
Springer US
Published in
Abdominal Radiology / Issue 3/2021
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-020-02750-w

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