Keywords:
Trauma, Endocrine disorders, Contrast agent-intravenous, CT, Emergency
Authors:
N. M. Buitrago Sanchez, M. Martí De Gracia, C. Rubio Hervás, S. Martín Pérez, C. Simón Selva, D. Mollinedo, A. Díez Tascón, P. Millán Estañ, S. Yus Teruel; Madrid/ES
DOI:
10.1594/ecr2013/C-2285
Results
Of 848 trauma patients admitted to the ICU for monitoring,
we identified 20 cases of AH,
ie 2% incidence (similar to other series in the literature).
13 cases were male (65%) and 7 cases were women (35%).
The mean age was 46 years (14 years younger and 80 years older).
See Figs.
3 and 4.
The main mechanisms of trauma were 551 traffic accidents (65%) and 162 falls from a height / falls (19%),
with the remaining 135 explained by other mechanisms.
The cases were distributed as follows: 13 in the right adrenal gland,
6 on the left and one case with bilateral involvement (Figs.
5,
6 and 7). This finding is consistent with the pathophysiological mechanism that makes it vulnerable to the right gland by its proximity to the liver and its direct venous drainage into the inferior cava vein,
which can transmit the intraabdominal pressure surge with greater efficiency than the left side,
where the adrenal vein drains into the renal vein.
On CT,
the adrenal trauma is often an incidental finding associated with other more serious injuries.
It can be unnoticed in cases of massive retroperitoneal hemorrhage.
In our study,
90% showed fat stranding surrounding the gland. Other signs of adrenal trauma on CT are the presence of a round or oval lesion at the theoretical site of the glands (often difficult to differentiate from other adrenal focal lesions) and a high value of attenuation (50-60 HU).
The injury most often associated was liver laceration (50%; Fig.
8),
followed by splenic laceration (32%; Fig.
9),
pulmonary contusion with or without hemopneumothorax (30%; Fig.
10) and renal contusion (16%; Fig.
11).
The patient with bilateral involvement was the only one who suffered adrenal insufficiency and required hormone replacement therapy with corticosteroids.
Four patients died (mortality 22%).
All deaths were attributed to associated injuries.