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      Sudden onset flank pain: a case report of retroperitoneal hemorrhage secondary to a ruptured adrenal hemangioma

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          Abstract

          Background

          Acute abdominal pain is a common complaint of patients presenting at the emergency department (ED). It can be caused by a broad spectrum of diseases. Providing care for patients with acute abdominal pain requires familiarity with the epidemiology, prevalence, and presentation of abdominal pathology, as well as a working knowledge of the differential diagnoses.

          Case report

          In this article, we discuss a case of spontaneous rupture of adrenal hemangioma with large retroperitoneal hemorrhage in a 31-year-old female.

          Discussion

          Emergency physicians regularly encounter uncommon causes of abdominal pain. Spontaneous rupture of adrenal hemangioma is an extremely rare cause of abdominal pain, but proper understanding of the disease process will aid clinicians to make a final diagnosis and ensure appropriate treatment. In this study, presentations and risk factors for spontaneous, atraumatic rupture of adrenal hemangioma as well as ED management and definitive treatment options are discussed.

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          Most cited references 21

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          Imaging of nontraumatic hemorrhage of the adrenal gland.

          Nontraumatic hemorrhage of the adrenal gland is uncommon. The causes of such hemorrhage can be classified into five categories: (a) stress, (b) hemorrhagic diathesis or coagulopathy, (c) neonatal stress, (d) underlying adrenal tumors, and (e) idiopathic disease. Computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging play an important role in diagnosis and management. CT is the modality of choice for evaluation of adrenal hemorrhage in a patient with a history of stress or a hemorrhagic diathesis or coagulopathy (anticoagulant therapy). CT may yield the first clue to the diagnosis of adrenal insufficiency secondary to bilateral massive adrenal hemorrhage; such insufficiency is rare but life threatening. US is the modality of choice for evaluation of neonatal hematoma, and MR imaging is helpful for further characterization. MR imaging is also useful in the diagnosis of coexistent renal vein thrombosis. When an adrenal abscess is suspected, percutaneous aspiration and drainage under imaging guidance should be performed. Hemorrhage into an adrenal cyst or tumor can cause acute onset of symptoms and signs in a patient without discernible risk factors for adrenal hemorrhage. A hemorrhagic adrenal tumor should be suspected when CT or MR imaging reveals a hemorrhagic adrenal mass of heterogeneous attenuation or signal intensity that demonstrates enhancement.
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            Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome.

            Spontaneous retroperitoneal hematoma (SRH) can be fatal, requiring immediate recognition and intervention. Current literature is limited, providing little direction in patient care. To describe clinical characteristics of patients with SRH during an 8-year period. Observational cohort study of all consecutive patients 18 years and older with SRH from January 2000 to December 2007. SRH was defined as unrelated to invasive procedures, surgery, trauma, or abdominal aortic aneurysm. Of 346 patients screened, 89 were eligible. Median age was 72 years; 56.2% were male. Overall, 66.3% were anticoagulated: 41.6% on warfarin, 30.3% heparin, and 11.2% low-molecular-weight heparin; 30.3% were on antiplatelet therapy; 16.5% were taking both anticoagulant and antiplatelet medications; 15.3% were taking neither. Primary presentation to the Emergency Department was seen in 36%; 64% developed SRH during inpatient anticoagulation therapy. The most common symptom was pain: abdominal (67.5%), leg (23.8%), hip (22.5%), and back (21.3%); 10.1% were misdiagnosed upon their initial encounter. Computed tomography (CT) was performed in 98.8%, ultrasound in 22.1%, and magnetic resonance imaging in 3.5%. Of all subjects, 40.4% were managed in an intensive care unit; 24.7% underwent interventional radiology (IR) procedures and 6.7% surgical evacuation; 75.3% received blood transfusion. Mortality was 5.6% within 7 days, 10.1% within 30 days, and 19.1% within 6 months. SRH is uncommon but potentially lethal, with a non-specific presentation that can lead to misdiagnosis. One-third of the cohort was not taking anticoagulants. CT was effective at identification. Most patients received aggressive management with transfusion or IR procedures. Published by Elsevier Inc.
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              Retroperitoneal hemorrhage secondary to a ruptured cavernous hemangioma.

               T Forbes (2005)
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                31 July 2018
                : 11
                : 1421-1424
                Affiliations
                [1 ]Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China, zhuweidong-1981@ 123456163.com
                [2 ]Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China, zhuweidong-1981@ 123456163.com
                Author notes
                Correspondence: Weidong Zhu, Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yi Shan Road, Shanghai 200233, China, Tel +86 21 6436 9181, Fax +86 21 6408 3783, Email zhuweidong-1981@ 123456163.com
                Article
                jpr-11-1421
                10.2147/JPR.S160661
                6074836
                © 2018 Peng et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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