Adrenal gland hematomas in trauma patients.

Abstract

To evaluate the frequency of detection of trauma-induced adrenal gland hematoma in current practice by using computed tomography (CT) and to correlate presence of adrenal hematoma with quantitative clinical indicators of injury severity. The radiology information system and the trauma registry were searched for cases of adrenal hematoma detected at trauma CT during a 54-month period. CT images depicting adrenal masses with the published characteristics of adrenal hematoma were reviewed by readers who were unblinded to the initial interpretations. Injury severity score (ISS), associated injury, and patient outcome data were gleaned from the trauma registry. The control group comprised patients entered in the trauma registry during the study period who did not have a diagnosis of adrenal hematoma. Fifty-four adrenal hematomas were detected in 51 patients: 42 with right-gland, 12 with left-gland, and three with bilateral lesions. The hematomas were round or ovoid and had a mean maximum diameter of 2.8 cm +/- 0.7 (SD) and a mean attenuation of 52 HU +/- 12. Periadrenal stranding was seen with 48 (89%) hematomas. At follow-up CT, 32 of 35 hematomas had resolved or decreased in size and attenuation. One patient with adrenal hematoma had no other intraabdominal injuries. Compared with the 6,757 control patients, the 51 patients with adrenal hematoma had a higher mortality rate (10% vs 4%; P <.001, chi(2) test) and a higher mean ISS (25.2 vs 9.7; P <.01, t test). Adrenal hematoma was found in 24 (0.4%) of 5,665 trauma patients with an ISS of 0-19, as compared with six (5.0%) of 122 patients with an ISS of 40 or higher. Adrenal hematoma was detected in 51 (1.9%) of 2,692 trauma patients who underwent CT, or 0.8% of all patients (n = 6,808) entered in the trauma registry. Compared with the other trauma patients, the patients with adrenal hematomas had severe injuries associated with higher mortality.