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 bleeding related to closed abdominal trauma. Due to the retroperitoneal location of the adrenal gland, protected by other organs, AAB is a not very prevalent entity so its therapeutic strategy is not well standardized. 

AAB is usually identified in CT as a well-defined, heterogeneous and non-enhancing adrenal mass (corresponding to the hematoma), which may be surrounded by trabeculation of  the adjacent retroperitoneal fat of the perirenal space, and/or active extravasation after intravenous contrast administration.

By angiography, AAB is recognized as a contrast extravasation after the selective microcatheterization of the adrenal arteries. Once identified, the bleeding can be embolized with different materials such as microcoils, microparticles or sclerosing liquids.