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      Bilateral adrenal haemorrhages: a crucial incidental finding

      case-report
      , MBBS 1 , , , MBBS, FRACP 2,3
      BJR Case Reports
      The British Institute of Radiology

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          Abstract

          Adrenal haemorrhage is a rare condition that has the potential to cause life-threatening adrenal insufficiency, especially if it affects both the adrenal glands. The difficulty in diagnosing adrenal haemorrhages lies in the non-specific clinical presentation including hypotension and abdominal pain. The following case report demonstrates the possible clinical presentations of non-traumatic adrenal haemorrhages and the method of diagnosing and treating adrenal insufficiency. In a medical era where overdiagnosis and “incidentalomas” are becoming more prevalent, this case nicely demonstrates the fortunate use of imaging to detect a potentially life-threatening condition.

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          Most cited references11

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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 non-aortic retroperitoneal hemorrhage: etiology, imaging characterization and impact of MDCT on management. A multicentric study.

            The purpose of this multicentric study is to assess the usefulness of multiphasic Computed tomography in the identification of spontaneous non-traumatic retroperitoneal hematoma (SRH) and its management, with references to the role of interventional radiology.
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              Imaging of the adrenal gland lesions

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                Author and article information

                Contributors
                Journal
                BJR Case Rep
                BJR Case Rep
                bjrcr
                BJR Case Reports
                The British Institute of Radiology
                2055-7159
                2017
                08 December 2016
                : 3
                : 2
                : 20160107
                Affiliations
                [1] 1Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital , Sydney, NSW, Australia
                [2] 2Department of Respiratory Medicine, Royal Prince Alfred Hospital , Sydney, NSW, Australia
                [3] 3Sydney Medical School, University of Sydney , Sydney, NSW, Australia
                Author notes
                Address correspondence to: Dr Soo-Min Cho E-mail: soomin089@ 123456gmail.com
                Article
                bjrcr.20160107
                10.1259/bjrcr.20160107
                6159250
                84387fae-5b77-4e8a-8125-c4d5fa97f82b
                © 2016 The Authors. Published by the British Institute of Radiology

                This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

                History
                : 08 August 2016
                : 01 November 2016
                : 04 November 2016
                Categories
                Case Report
                bjrcr, BJR|case reports
                end-sys, Endocrine system
                gas-abd, Gastrointestinal and abdominal
                ct, CT

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