EURORAD ESR

Case 13820

Isolated adrenal post-traumatic haematoma: CT and MRI findings

Author(s)
Tonolini Massimo, M.D.; Adriana Vella, M.D.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 54 year(s)
 
 
  • Figure 1
    Ultrasound at admission

    Longitudinal ultrasound scan of the right hemiabdomen showed a well-demarcated, moderate-sized (see calipers) ovoid lesion (arrows) in the anatomic site of the adrenal gland, approximately isoechoic compared to the...

     
    Area of Interest: Adrenals; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 2
    Unenhanced and post-contrast multidetector CT
     

    Preliminary unenhanced scan confirmed the presence of a well-demarcated ovoid right adrenal mass lesion (arrow) measuring 44-46 Hounsfield Units attenuation, without fat stranding or blood in the surrounding fat....

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

    Axial (b) and coronal (c) arterial phase images did not show abnormal enhancement of the right adrenal mass lesion (arrows), nor active contrast extravasation.

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

    Axial (b) and coronal (c) arterial phase images did not show abnormal enhancement of the right adrenal lesion (arrows), nor active contrast extravasation. Mild fat stranding was noted in the caudal perinephric space (+).

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

    On axial (d) and coronal (e) portal venous phase images the right adrenal lesion (arrows) did not enhance internally, with minimal peripheral and septal enhancement.

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

    On axial (d) and coronal (e) portal venous phase images the right adrenal lesion (arrows) did not enhance internally, with minimal peripheral and septal enhancement. Note mild fat stranding at the caudal perinephric...

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

    Similarly, the right adrenal mass lesion (arrow) did not enhance internally in the delayed phase, and showed minimal peripheral and septal enhancement.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 3
    Unenhanced MRI
     

    Coronal (a) and axial (b) T2-weighted images confirmed ovoid right adrenal lesion (arrows) with heterogeneously hyperintense signal, demarcated by thin peripheral low-intensity rim.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Coronal (a) and axial (b) T2-weighted images confirmed ovoid right adrenal lesion (arrows) with heterogeneously hyperintense signal, demarcated by thin peripheral low-intensity rim.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Axial fat-saturated T2-weighted image confirmed ovoid right adrenal lesion (arrow) with heterogeneously hyperintense signal, without appreciable oedema of the surrounding fat.

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Axial T1-weighted (d, e with fat suppression, f out-phase gradient-echo) showed the ovoid right adrenal lesion (arrows) with persistently hyperintense signal consistent with extracellular methaemoglobin, demarcated by...

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Axial T1-weighted (d, e with fat suppression, f out-phase gradient-echo) showed the ovoid right adrenal lesion (arrows) with persistently hyperintense signal consistent with extracellular methaemoglobin, demarcated by...

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Axial T1-weighted (d, e with fat suppression, f out-phase gradient-echo) showed the ovoid right adrenal lesion (arrows) with persistently hyperintense signal consistent with extracellular methaemoglobin, demarcated by...

     
    Area of Interest: Adrenals; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 4
    Follow-up contrast-enhanced CT

    Repeated portal venous phase CT acquisition showed right adrenal lesion with unchanged appearance compared to Fig. 2d.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
Longitudinal ultrasound scan of the right hemiabdomen showed a well-demarcated, moderate-sized (see calipers) ovoid lesion (arrows) in the anatomic site of the adrenal gland, approximately isoechoic compared to the liver parenchyma. Absent haemoperitoneum.
 
Preliminary unenhanced scan confirmed the presence of a well-demarcated ovoid right adrenal mass lesion (arrow) measuring 44-46 Hounsfield Units attenuation, without fat stranding or blood in the surrounding fat. Absent haemoperitoneum.
 
Axial (b) and coronal (c) arterial phase images did not show abnormal enhancement of the right adrenal mass lesion (arrows), nor active contrast extravasation.
 
Axial (b) and coronal (c) arterial phase images did not show abnormal enhancement of the right adrenal lesion (arrows), nor active contrast extravasation. Mild fat stranding was noted in the caudal perinephric space (+).
 
On axial (d) and coronal (e) portal venous phase images the right adrenal lesion (arrows) did not enhance internally, with minimal peripheral and septal enhancement.
 
On axial (d) and coronal (e) portal venous phase images the right adrenal lesion (arrows) did not enhance internally, with minimal peripheral and septal enhancement. Note mild fat stranding at the caudal perinephric space (+).
 
Similarly, the right adrenal mass lesion (arrow) did not enhance internally in the delayed phase, and showed minimal peripheral and septal enhancement.
 
Coronal (a) and axial (b) T2-weighted images confirmed ovoid right adrenal lesion (arrows) with heterogeneously hyperintense signal, demarcated by thin peripheral low-intensity rim.
 
Coronal (a) and axial (b) T2-weighted images confirmed ovoid right adrenal lesion (arrows) with heterogeneously hyperintense signal, demarcated by thin peripheral low-intensity rim.
 
Axial fat-saturated T2-weighted image confirmed ovoid right adrenal lesion (arrow) with heterogeneously hyperintense signal, without appreciable oedema of the surrounding fat.
 
Axial T1-weighted (d, e with fat suppression, f out-phase gradient-echo) showed the ovoid right adrenal lesion (arrows) with persistently hyperintense signal consistent with extracellular methaemoglobin, demarcated by thin peripheral low-intensity rim.
 
Axial T1-weighted (d, e with fat suppression, f out-phase gradient-echo) showed the ovoid right adrenal lesion (arrows) with persistently hyperintense signal consistent with extracellular methaemoglobin, demarcated by thin peripheral low-intensity rim.
 
Axial T1-weighted (d, e with fat suppression, f out-phase gradient-echo) showed the ovoid right adrenal lesion (arrows) with persistently hyperintense signal consistent with extracellular methaemoglobin, demarcated by thin peripheral low-intensity rim.
 
Repeated portal venous phase CT acquisition showed right adrenal lesion with unchanged appearance compared to Fig. 2d.
 
 
 
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