EURORAD ESR

Case 12473

High-grade iatrogenic renal injury after adrenalectomy

Author(s)
Tonolini Massimo, M.D.

"Luigi Sacco" University Hospital
Radiology Department
Via G.B. Grassi 74
20157 Milan, Italy
Email:mtonolini@sirm.org
 
Patient
female, 45 year(s)
 
 
  • Figure 1
    Haemoglobin trend during 9 days of hospitalization including preoperative examination

    Graphs shows trend of haemoglobin drop from pre-surgery (14 g/dL) to nadir 8.2 g/dL during postoperative hospitalization.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Laboratory tests; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 2
    Early postoperative unenhanced and post-contrast multidetector CT
     

    Unenhanced (a,b) and post-contrast (c) axial CT images showed a 5 cm fluid collection (*) with gas bubbles in the site of resection of right adrenal mass (note metallic clip abutting the inferior vena cava contour).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Unenhanced (a,b) axial CT images showed minimal posterior pararenal blood (+), and gas collections (thin arrows) in the ipsilateral abdominal wall.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Nephrographic phase post-contrast axial CT image showed a 5 cm fluid collection (*) with gas bubbles in the site of resection of right adrenal mass, with some fluid surrounding the inferior vena cava.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    The right kidney showed upper-normal limit size and parenchymal thickness, near-complete devascularization in the nephrographic phase (d,e) save for partial capsular enhancement (rim sign, arrowheads).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    The right kidney showed upper-normal limit size and parenchymal thickness, near-complete devascularization in the nephrographic phase (d,e) save for partial capsular enhancement (rim sign, arrowheads).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Excretory-phase CT images (f...i) confirmed fluid collection (*) with gas bubbles in the site of resection of adrenal mass, near-complete devascularization of the ipsilateral kidney, and excluded urine extravasation.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Excretory-phase CT images (f...i) confirmed near-complete devascularization of the ipsilateral kidney, and excluded urine extravasation. Note normal contralateral kidney.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Excretory-phase CT images (f...i) confirmed near-complete devascularization of the ipsilateral kidney, minimal gas collections (thin arrows) in the ipsilateral abdominal wall.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Excretory-phase CT images (f...i) confirmed near-complete devascularization of the ipsilateral kidney save for partial capsular enhancement (rim sign, arrowheads).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 3
    Follow-up contrast-enhanced multidetector CT 3 weeks later
     

    Repeated contrast-enhanced CT showed minimal decrease, fluid-like hypoattenuation and better demarcation of postoperative collection (*) in the site of resection of right adrenal mass.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Repeated contrast-enhanced CT showed persistent near-complete devascularization of the right kidney save for partial capsular enhancement ("rim sign", arrowheads).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Repeated contrast-enhanced CT showed persistent near-complete devascularization of the right kidney save for partial capsular enhancement ("rim sign", arrowheads).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 4
    Distant follow-up multidetector CT one year later
     

    Follow-up contrast-enhanced CT showed atrophied right kidney (arrows), without signs of tumour recurrence in the site of resection of adrenal mass.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;

    Follow-up contrast-enhanced CT showed atrophied right kidney (arrows), without signs of tumour recurrence in the site of resection of adrenal mass.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Complications; Special Focus: Ischaemia / Infarction;
     
     
Graphs shows trend of haemoglobin drop from pre-surgery (14 g/dL) to nadir 8.2 g/dL during postoperative hospitalization.
 
Unenhanced (a,b) and post-contrast (c) axial CT images showed a 5 cm fluid collection (*) with gas bubbles in the site of resection of right adrenal mass (note metallic clip abutting the inferior vena cava contour).
 
Unenhanced (a,b) axial CT images showed minimal posterior pararenal blood (+), and gas collections (thin arrows) in the ipsilateral abdominal wall.
 
Nephrographic phase post-contrast axial CT image showed a 5 cm fluid collection (*) with gas bubbles in the site of resection of right adrenal mass, with some fluid surrounding the inferior vena cava.
 
The right kidney showed upper-normal limit size and parenchymal thickness, near-complete devascularization in the nephrographic phase (d,e) save for partial capsular enhancement (rim sign, arrowheads).
 
The right kidney showed upper-normal limit size and parenchymal thickness, near-complete devascularization in the nephrographic phase (d,e) save for partial capsular enhancement (rim sign, arrowheads).
 
Excretory-phase CT images (f...i) confirmed fluid collection (*) with gas bubbles in the site of resection of adrenal mass, near-complete devascularization of the ipsilateral kidney, and excluded urine extravasation.
 
Excretory-phase CT images (f...i) confirmed near-complete devascularization of the ipsilateral kidney, and excluded urine extravasation. Note normal contralateral kidney.
 
Excretory-phase CT images (f...i) confirmed near-complete devascularization of the ipsilateral kidney, minimal gas collections (thin arrows) in the ipsilateral abdominal wall.
 
Excretory-phase CT images (f...i) confirmed near-complete devascularization of the ipsilateral kidney save for partial capsular enhancement (rim sign, arrowheads).
 
Repeated contrast-enhanced CT showed minimal decrease, fluid-like hypoattenuation and better demarcation of postoperative collection (*) in the site of resection of right adrenal mass.
 
Repeated contrast-enhanced CT showed persistent near-complete devascularization of the right kidney save for partial capsular enhancement ("rim sign", arrowheads).
 
Repeated contrast-enhanced CT showed persistent near-complete devascularization of the right kidney save for partial capsular enhancement ("rim sign", arrowheads).
 
Follow-up contrast-enhanced CT showed atrophied right kidney (arrows), without signs of tumour recurrence in the site of resection of adrenal mass.
 
Follow-up contrast-enhanced CT showed atrophied right kidney (arrows), without signs of tumour recurrence in the site of resection of adrenal mass.
 
 
 
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