Abstract
BackgroundAdrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries. Alternatively, isolated adrenal gland trauma is extremely rare, accounting for only 1.5 to 4% of all adrenal trauma cases. While isolated adrenal trauma is a mostly self-limiting condition, it is potentially life-threatening, representing a significant cause of bleeding, and/or hypotension due to adrenal insufficiency and adrenal crisis. Due to its rare occurrence, there are no reported guidelines for monitoring and observing isolated adrenal trauma.Case presentationHere we report on an isolated adrenal hemorrhage from a blunt trauma without associated injuries. A 53-year-old white man presented with abdominal pain after a high-speed motor vehicle accident. An initial evaluation revealed minimal abdominal pain and negative focused assessment with sonography for trauma examination; computed tomography imaging revealed a significant fluid collection consistent with adrenal hemorrhage. He was observed in our intensive care unit for 24 hours, and had stable hemoglobin and vital signs, after which he was discharged. At 1-month follow-up, he reported persistent intermittent abdominal pain, which was completely resolved by the 4-month follow-up.ConclusionsThis case report demonstrates isolated adrenal gland injury resulting from significant blunt trauma to the abdomen. There are no current guidelines for monitoring isolated adrenal hemorrhage. Recognizing possible adrenal injury in blunt trauma cases is important due to potentially severe adrenal hemorrhage; therefore, we recommend follow-up with serial abdominal computed tomography until the resolution of hemorrhage and symptoms.
Highlights
Adrenal gland trauma is a rare condition that typically stems from blunt force trauma, and is associated with multiple organ injuries
This case report demonstrates isolated adrenal gland injury resulting from significant blunt trauma to the abdomen
There are no current guidelines for monitoring isolated adrenal hemorrhage
Summary
We reported here a rare case of isolated unilateral adrenal injury with hemorrhage from blunt trauma. The presence of adrenal neoplasm presenting as possible adrenal hemorrhage is described [19,20,21]. The need to follow-up and to rule out an underlying adrenal neoplasm should be considered, due to possible hemorrhage into a pre-existing adrenal mass. There are no guidelines for follow-up for an isolated traumatic adrenal hemorrhage and, if documented, resolution or absence of underlying neoplasm is required due to the rarity of these cases. The diagnostic challenge in this case is the necessary clinical and radiologic follow-up for isolated adrenal hemorrhage. We propose an interval CT follow-up at 1 to 4 months for large, > 4 cm, adrenal gland hemorrhage based on known likelihood of incidental adenomas < 4 cm, with typical radiologic findings, such as smooth and homogenous lesions, to have low risk of malignancy [22]. If adenoma cannot be ruled out, it may be beneficial to complete a biochemical analysis at the follow-up to rule out functioning adenomas
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