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 man with 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 angiomyolipoma, with peripheral fat trabeculation in the right perirenal space. The adrenal mass had an increase of size compared to prior studies ( Fig. 2 ).
Due to the high suspicion of AAB a diagnostic angiography of the right adrenal gland was performed. Arteriography showed a small contrast extravasation from a branch of the middle adrenal artery ( Fig. 3 ).
An embolization of the middle adrenal artery with a 2 x 40 mm microcoil and 250 µm microparticles was performed. Subsequently, a selective arteriography of the upper and inferior adrenal artery was carried out with no evidence of complications active bleeding after procedure ( Fig. 4 ).
Case 2:
A 52-year-old woman consulted with left hypochondrium pain uncontrollable with conventional analgesia. Abdominal CT showed an spontaneous left adrenal hematoma with associated signs of retroperitoneal hemorrhage without active extravasation of contrast. Subsequently, due to affectation of the general condition of the patient, an angiography with a diagnostic and therapeutic purpose was performed (Fig. 5).
The left inferior adrenal artery was catheterized with a microcatheter and embolized with 200 and 400 µm microparticles.
Correct devascularization of the treated artery was achieved in successive series (Fig. 6). Patient improved clinically after embolization procedure.
Case 3:
A 35-year-old man was transferred to the Emergency Department after suffering a high-energy traffic accident. Abdominal CT was performed where a large retroperitoneal hematoma with laceration of the left adrenal gland was identified. A supraselective catheterization of the left inferior adrenal artery was performed and a heterogeneous enhancement was observed due to fragmentation of the gland (Fig. 7).
An embolization of the gland was performed with microparticles.
Inferior adrenal artery devascularization was evidenced in control l angiography. The upper and middle adrenal arteries were also checked and the presence of active bleeding was ruled out (Fig. 8).
Case 4:
A 41-year-old man attended Emergency Department after suffering a high-energy accident with his motorcycle. A grade IV hepatic laceration was identified in the thoracoabdominal multiphase CT performed. In addition, a perirenal space fat trabeculation was visualized with a small focus of active contrast extravasation that was oriented as renal active bleeding ( Fig. 9 ).
A diagnostic renal arteriography was performed where no bleeding from the kidney was observed; however, an adrenal bleeding that depends on the middle adrenal branch was identified ( Fig. 10 ).
After microcatheterization of the middle adrenal artery, an embolization was performed with a solution of "Spongostan" and N-Acetyl-Cyanoacrylate. Correct embolization of the treated artery without signs of bleeding was observed in later series ( Fig. 11 ).