Two cases of atraumatic adrenal hemorrhage: A review of active management, conservative management, and challenges faced

Aditya Sakalkale; Colin Chan-Min Choi; Russel Krawitz; Justin M C Yeung

doi:10.1016/j.radcr.2024.03.005

Two cases of atraumatic adrenal hemorrhage: A review of active management, conservative management, and challenges faced

Radiol Case Rep. 2024 Mar 26;19(6):2395-2401. doi: 10.1016/j.radcr.2024.03.005. eCollection 2024 Jun.

Authors

Aditya Sakalkale¹, Colin Chan-Min Choi¹, Russel Krawitz¹, Justin M C Yeung^{2

3}

Affiliations

¹ Department of General Surgery, Western Health, Melbourne, Australia.
² Department of Colorectal Surgery, Western Health, Melbourne, Australia.
³ Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Australia.

Abstract

Adrenal hemorrhage (AH) is an uncommon and potentially disastrous affliction that carries an accepted mortality risk of 15%. Variable symptomatology can cause a diagnostic dilemma and may be missed. We present 2 cases of right-sided AH; both cases were initially presumed to be renal colic. Case 1 was an 86-year-old gentleman, presenting with right flank pain found to have a right-sided atraumatic AH. He presented with hemorrhagic shock, requiring angioembolization of the bleeding vessel. Case 2 was a 62-year-old gentleman who presented with right flank pain and was found to have a right-sided atraumatic AH. He was hemodynamically stable and successfully managed conservatively. Adrenal hemorrhage is a potentially fatal affliction that may be missed. CT scans are the recommended imaging modality during an acute presentation due to wider availability and fast assessment. We demonstrate a hemodynamically stable patient managed with a 'watch and wait' approach and an unstable patient managed with resuscitation followed by urgent angioembolization.

Keywords: Adrenal hemorrhage; Angioembolization; Case series.

Publication types

Case Reports