Pediatric Adrenal Hemorrhage

  • Etiology: Adrenal is compressed between liver and kidney and right adrenal vein drains directly into inferior vena cava (left adrenal vein drains into left renal vein)
  • Imaging:
    — Solid or mixed solid and cystic lesion which decreases in size on serial imaging
    — Can cause non-masslike adrenal calcifications
    — 75% on right and 10% bilateral
  • DDX:
    — Normal neonatal adrenal gland is very large and has thick hypoechoic cortex and can be up to one third the size of kidney
    — Neuroblastoma arising from the adrenal gland so negative laboratory studies and serial ultrasound exams with decreasing mass size are key to differentiating between adrenal hemorrhage and neuroblastoma
  • Complications:
  • Treatment: Surveillance until resolution
  • Clinical:

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.
US of bilateral adrenal hemorrhage
AXR (above) shows faint linear calcification in the adrenal glands bilaterally. Sagittal US of the left adrenal gland (below left) and right adrenal gland (below right) show the adrenal glands to be slightly enlarged and to have central echogenic foci within them.
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.
CT of adrenal hemorrhage
Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen show a right adrenal mass of intermediate density. On follow-up ultrasound exams, the mass was seen to resolve over several months.