- Adrenal hemorrhage occurs secondary to both traumatic conditions and atraumatic conditions.
- Atraumatic causes of adrenal hemorrhage include:
- Hemorrhagic diathesis or coagulopathy;
- Neonatal stress;
- Underlying adrenal tumors;
- Idiopathic disease.
- The large majority of patients with adrenal hemorrhage do not have clinically obvious signs of adrenal insufficiency; the diagnosis is usually made incidentally at imaging performed for another reason.
 Imaging Findings
- Adenral hematomas characteristically appear round or oval
- Stranding of the periadrenal fat is evident as well.
- Attenuation value of adenal hematoma depends on its age.
- Acute to subacute hematomas contain areas of high attenuation that usually range from 50 to 90 HU.
- Adrenal hematomas decrease in size and attenuation over time, and most resolve completely.
- Adrenal hematoma may calcify after 1 year.
- Organized chronic adrenal hematoma appears as a mass with a hypoattenuating center with or without calcifications. Such masses are termed adrenal pseudocysts.
- Pattern of echogenicity of an adrenal hematoma depends on its age
- Early-stage hematoma appears solid with diffuse or inhomogeneous echogenicity.
- As liquefaction occurs, the mass demonstrates mixed echogenicity with a central hypoechoic region and eventually becomes completely anechoic and cystlike. C
- Calcifications may be seen in the walls of the hematoma as early as 1–2 weeks after onset and gradually compact as the blood is absorbed.
- Color Doppler and power Doppler imaging allow confirmation of the avascular nature of the mass.
- Acute stage (less than 7 days after onset): the hematoma typically appears isointense or slightly hypointense on T1-weighted images and markedly hypointense on T2-weighted images.
- Subacute stage (7 days to 7 weeks after onset): the hematoma appears hyperintense on T1- and T2-weighted images.
- Chronic stage (which typically begins 7 weeks after onset): a hypointense rim is present on T1- and T2-weighted images, which is attributed to hemosiderin deposition and the presence of a fibrous capsule.
Patient #1: Bilateral adrenal hemorrhage
 External Links
- Akira Kawashima, Carl M. Sandler, Randy D. Ernst, Naoki Takahashi, Marilyn A. Roubidoux, Stanford M. Goldman, Elliot K. Fishman, and N. Reed Dunnick. Imaging of Nontraumatic Hemorrhage of the Adrenal Gland. RadioGraphics 1999 19: 949-963.