EURORAD ESR

Case 11837

Bilateral adrenal haemorrhage caused by antiphospholipid antibody syndrome

Author(s)
Oliveira, Carlos; Costa, Rui; Couto, Tiago; Estêvão, Amélia

University Hospital of Coimbra,
Faculty of Medicine,
Medical Imaging Department;
Praceta Mota Pinto
3000 Coimbra, Portugal;
Email:carlos.mig.oliveira@gmail.com
 
Patient
female, 75 year(s)
 
 
  • Figure 1
    CT of the abdomen at the adrenals level
     

    Unenhanced CT of the abdomen - 14 days after surgery - Hyperattenuating 4cm mass at the right adrenal site and a subcapsular hepatic fluid collection. No abnormal findings were visible on the left adrenal gland.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Constrast-enhanced CT - portal phase - 14 days after surgery - Both the sucapsular hepatic collection and the right adrenal mass showed no contrast enhancement.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Interventional radiology procedure - drainage of biloma

    Drainage of hepatic biloma - There was no sign of infection on the cytologic and analytic studies of the drained fluid.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Drainage; Special Focus: Abscess; Infection;
     
     
  • Figure 3
    CT of the abdomen 15 days after the first CT
     

    Unenhanced CT fifteen days after the first CT - hyperattenuating mass on the left adrenal, compatible with haemorrhage. The right adrenal is now slightly less hyperdense than before. The previous biloma resolved...

     
    Area of Interest: Abdomen; Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    CECT fifteen days after the first CT - small thrombus is seen as a filling defect in a branch of the left pulmonary artery - pulmonary embolism.

     
    Area of Interest: Thorax; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    CECT fifteen days after the first CT - partial filling defect in the inferior vena cava.

     
    Area of Interest: Abdomen; Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    CECT fifteen days after the first CT - The two adrenals didn't enhance following contrast administration, keeping the same density (around 60-70HU).

     
    Area of Interest: Abdomen; Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    CECT fifteen days after the first CT - non-enhancing wedge-shaped hypodense image in the spleen, related to a small splenic infarct.

     
    Area of Interest: Spleen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis; Ischaemia / Infarction;

    CECT fifteen days after the first CT - a hypodense image is seen in the lumen of the left renal vein.

     
    Area of Interest: Abdomen; Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;
     
     
Unenhanced CT of the abdomen - 14 days after surgery - Hyperattenuating 4cm mass at the right adrenal site and a subcapsular hepatic fluid collection. No abnormal findings were visible on the left adrenal gland.
 
Constrast-enhanced CT - portal phase - 14 days after surgery - Both the sucapsular hepatic collection and the right adrenal mass showed no contrast enhancement.
 
Drainage of hepatic biloma - There was no sign of infection on the cytologic and analytic studies of the drained fluid.
 
Unenhanced CT fifteen days after the first CT - hyperattenuating mass on the left adrenal, compatible with haemorrhage. The right adrenal is now slightly less hyperdense than before. The previous biloma resolved completely.
 
CECT fifteen days after the first CT - small thrombus is seen as a filling defect in a branch of the left pulmonary artery - pulmonary embolism.
 
CECT fifteen days after the first CT - partial filling defect in the inferior vena cava.
 
CECT fifteen days after the first CT - The two adrenals didn't enhance following contrast administration, keeping the same density (around 60-70HU).
 
CECT fifteen days after the first CT - non-enhancing wedge-shaped hypodense image in the spleen, related to a small splenic infarct.
 
CECT fifteen days after the first CT - a hypodense image is seen in the lumen of the left renal vein.
 
 
 
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