Pediatric Adrenal Hemorrhage

  • Etiology: adrenal is compressed between liver + kidney and right adrenal vein drains directly into inferior vena cava (left adrenal vein drains into left renal vein)
  • Imaging: solid or mixed solid / cystic lesion which decreases in size on serial imaging, 75% on right, 10% bilateral
  • DDX: neuroblastoma arising from the adrenal gland, negative laboratory studies and serial ultrasound exams with decreasing mass size are key to differentiating between the two

Radiology Cases of Adrenal Hemorrhage

AXR of adrenal hemorrhage
AXR shows large triangle-shaped calcifications projecting over the right adrenal gland at the level of T10 and the left adrenal gland at the level of T11. These were noted to resolve over several months.
US of adrenal hemorrhge
Sagittal US of the left kidney shows a primarily cystic appearing left adrenal mass. Over months this mass was noted to decrease in size and disappear on serial ultrasound exams.
CT of adrenal hemorrhage
Axial, coronal, and sagittal CT with contrast of the abdomen shows a large right solid adrenal mass that decreased in size on serial US exams.