Genitourinary Radiology > Adrenal Glands > Adrenal Hemorrhage

Adrenal Hemorrhage


Adrenal hemorrhage may occur spontaneously due to septicemia, burn injury, recent surgery or adrenal neoplasm (particulary metastatic melanoma); or may be a result of blunt trauma, anticoagulant use, or adrenal venography. 20% of bilateral hemorrhages result in acute adrenal insufficiency (adrenal apoplexy).

CT findings include a non-enhancing, well-defined, round or oval mass lesion, usually 1-5 cm in diameter, classically showing focal or diffuse areas of increased attenuation (50-90 HU). However, lesions isodense to liver, non-enhanced renal cortex, or muscle are also common. When the cause of hemorrhage is removed, the lesion will decrease in size after a 6-month observation period.

Ultrasound shows a mildly hyperechoic mass with a brightly echogenic center.

MRI is the preferred method for diagnosing suspected hemorrhage, showing focal areas of a "ring pattern" of high signal intensity of T1 images which represent the presence of methemoglobin. T2-weighted images show low signal intensity in a ring pattern around the periphery of subacute and chronic hemorrhage.

Contrast enhanced CT scan through the right adrenal gland following a motor vehicle collision shows a liver laceration (arrows) and right adrenal hemorrhage/contusion (A).  The hematoma resolved on subsequent CT scans.

Same patient following coronal 3D reconstruction of original CT data shows the right adrenal hematoma (A) sitting atop the right kidney which also underwent trauma (note no enhancement to upper portion of right kidney (K) consistent with right upper pole renal infarction).

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