Teaching Case

47-year-old male patient was referred to our institution due to polytrauma. Abdominal ultrasound (US) was requested and showed abdominal fluid. Consequently, abdominal multi-slice computed tomography (MSCT) was performed, which confirmed the presence of the free intraabdominal fluid and spontaneously hyperdense ovoid masses in both adrenal glands.

Abdominal MSCT showed spontaneously hyperdense nodular masses (50 HU) in both adrenal glands, with ill-defined adrenal margins and infiltration of the surrounding fat. Also free fluid and splenic laceration. (Fig. 1 a-c)

Follow-up MSCT, four months later, showed resolution of the haematomas. (Fig. 1 d)

Adrenal gland haematomas are a rare condition associated with diffuse abdominal injury, and their presence is commonly correlated with high injury severity and mortality. [1]
Their incidence is estimated between 0.14%-1.8%. Although the causes of this condition can be multiple, trauma is the most frequent, but at the same time, it is very rare to see adrenal damage in general trauma (0.03%-4.5%) and in abdominal trauma there is a prevalence of 2%-3%. Panda et al reports an average presentation age of 32 years and that 95% of the haematomas are unilateral, the right adrenal gland being the most affected. The mortality rate is 15%. [1, 2]
The clinical symptoms are variable, and the traumatic precedent can guide to the accurate diagnosis. We can find abdominal pain, haemoglobin fall, weakness, nausea and vomiting, hypotension, flanks ecchymosis, diaphoresis; all non - specific clinical symptoms. Also, adrenal insufficiency.  [3]
Abdominal US is the first imaging method of choice to study polytrauma patients, with a “FAST protocol” in search of free fluid. Abdominal MSCT is the method of choice to analyse the adrenal glands and their lesions in trauma context. With an adequate time of image acquisition, excellent multiplanar resolution and intravenous (IV) contrast we can distinguish traumatic lesions from tumoral ones, confirm the US findings and identify multiorganic involvement. [1] The imaging findings are wide, from oval masses to ill-defined soft-tissue stranding around the adrenal gland (infiltration of blood through the retroperitoneal fat) and thickening of adrenal glands. [4]
The treatment is variable, with surgical resolution (adrenalectomy) or expectant behaviour if the patient is haemodynamically stable with glucocorticoid and mineralocorticoid treatment. [4]

Written informed patient consent for publication has been obtained.