Learning objectives
To review the vascular anatomy of the adrenal gland and the typical findings by CT and angiography of acute adrenal bleeding (AAB).
To report our experience in the endovascular treatment of AAB with 4 cases.
Background
The adrenal gland is irrigated by three main arteries, which are visualized by angiography in 57-92% of cases ( Fig. 1 ):
Superior suprarenal artery:
It usually originates from the ipsilateral inferior phrenic artery and less frequently from the aorta.
Middle suprarenal artery:
It usually originates from the aorta.
Inferior suprarenal artery:
It originates from the ipsilateral renal artery in most of the cases.
AAB is usually secondary to spontaneous hemorrhage of adrenal masses or high-energy adrenal trauma, only seen in 1-2% of all visceral...
Findings and procedure details
Few cases that illustrate the diagnosis and treatment of AAB, by endovascular embolization, had been described in the lastest literature. Therefore, we proceed to describir the four cases available in our institution.
Case 1:
A 68-year-old manwith known adrenal angiomyolipoma consulted due to pain in right hypochondrium / right iliac fossa to the Emergency Department. Portal venous CT was performed in order to rule out an acute cholecystitis. Body CT showed an heterogeneous right adrenal mass with a fatty component, related to the already known...
Conclusion
AAB is a very infrequent entity secondary mainly to blunt abdominal traumas or mass bleeding.
The normal vascular anatomy knowledge of the adrenal gland and the typical CT findings of the AAB are essential for diagnosis, therapeutic approach and the most appropriate selection of embolization material.
Personal information and conflict of interest
G. Rafart Martinez; Badalona/ES - nothing to disclose J. Sampere; Barcelona/ES - nothing to disclose G. A. Tovar Felice; Barcelona/ES - nothing to disclose V. Benito Santamaría; Barcelona/ES - nothing to disclose P. Puyalto de Pablo; Barcelona/ES - nothing to disclose A. Garcia Gamez; Saragossa/ES - nothing to disclose
References
•Fowler AM., Burda JF., Kim SK., Adrenal Artery Embolization: Anatomy, Indications and Technical considerations. AJR. 2013. •Dinc H, Simsek A, Ozyavuz R, Ozgur GK, Gumele HR. Endovascular treatment of massive retroperitoneal haemorrhage due to inferior adrenal artery injury: a case report. Acta Radiol 2002 •Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE. N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol 2004; 15:689–695 •Ikeda O, Urata J, Araki Y, et al. Acute adrenal hemorrhage after blunt trauma. Abdom Imaging...