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Messina F, Calabrese G, Tebala C, Turano L, Arcadi N. Retroperitoneal hematoma by different causes: Presentation of two emergency cases at computed tomography. Radiol Case Rep 2021; 16:2551-2556. [PMID: 34306286 PMCID: PMC8283137 DOI: 10.1016/j.radcr.2021.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 10/27/2022] Open
Abstract
Retroperitoneal hematoma is a rare clinical entity with variable aetiology, which is increasing in incidence mainly due to complications related to interventional procedures. The causes of RE are different. We present 2 suggestive cases of RE, one for renal cause and another of adrenal origin. Both came to our attention as a matter of urgency. Retroperitoneal hematoma, therefore, originated from different causes, with consequent different treatments. Both cases were diagnosed, as a matter of urgency, thanks to the use of contrast Computed Tomography, which allowed a rapid diagnosis, careful specialist evaluation, a monitoring of their clinical conditions, and a consequent adequate outcome for the patients.
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Affiliation(s)
- Francesco Messina
- Unit of Radiology, Riuniti Hospital, Azienda Ospedaliera Grande Ospedale Metropolitano (G.O.M.) "Bianchi-Melacrino-Morelli", Via Giuseppe Melacrino n.21, Reggio 89124, Calabria, Italy
| | - Grazia Calabrese
- Unit of Radiology, Riuniti Hospital, Azienda Ospedaliera Grande Ospedale Metropolitano (G.O.M.) "Bianchi-Melacrino-Morelli", Via Giuseppe Melacrino n.21, Reggio 89124, Calabria, Italy
| | - Carmela Tebala
- Unit of Radiology, Riuniti Hospital, Azienda Ospedaliera Grande Ospedale Metropolitano (G.O.M.) "Bianchi-Melacrino-Morelli", Via Giuseppe Melacrino n.21, Reggio 89124, Calabria, Italy
| | - Lorena Turano
- Unit of Radiology, Riuniti Hospital, Azienda Ospedaliera Grande Ospedale Metropolitano (G.O.M.) "Bianchi-Melacrino-Morelli", Via Giuseppe Melacrino n.21, Reggio 89124, Calabria, Italy
| | - Nicola Arcadi
- Unit of Radiology, Riuniti Hospital, Azienda Ospedaliera Grande Ospedale Metropolitano (G.O.M.) "Bianchi-Melacrino-Morelli", Via Giuseppe Melacrino n.21, Reggio 89124, Calabria, Italy
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Ketha S, Smithedajkul P, Vella A, Pruthi R, Wysokinski W, McBane R. Adrenal haemorrhage due to heparin-induced thrombocytopenia. Thromb Haemost 2017; 109:669-75. [DOI: 10.1160/th12-11-0865] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 01/09/2013] [Indexed: 11/05/2022]
Abstract
SummaryAdrenal haemorrhage (AH) is a rare but potentially devastating complication of heparin-induced thrombocytopenia (HIT). Neither the prevalence nor the natural history of AH due to HIT are known. The objectives of this study were to identify the spectrum of AH causes, to characterise the frequency of AH due to HIT and determine the natural history of HIT-associated AH. All patients with incident adrenal haemorrhage from January 2002 through June 2012 seen at the Mayo Clinic were identified. Over this time frame, there were a total of 115 patients with AH of which 11 cases (10%; mean age 67 ± 8 years; 73% female) were associated with HIT. Of these, all but one occurred in the postoperative setting and involved both adrenal glands (89%) with acute adrenal insufficiency at the time of diagnosis. Cases were found incidentally during an evaluation for fever, shock, abdominal pain or mental status changes. All HIT patients experienced venous thrombosis at other locations including deep venous thromboses (n=14), pulmonary emboli (n= 4) and arterial thrombosis (n=2). Four patients undergoing total knee arthroplasty had “spontaneous HIT” with AH in the absence of identifiable heparin exposure. Other causes of AH included trauma (29%), sepsis (15%), antiphospholipid antibody syndrome (10%), and metastatic disease (12%). In conclusion, AH is an important but seldom recognised presumed thrombotic complication of HIT, which usually occurs in the postoperative period, especially after orthopaedic procedures. This syndrome can occur in the apparent absence of heparin exposure, especially following major joint replacement surgery.
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Adrenal artery embolization: anatomy, indications, and technical considerations. AJR Am J Roentgenol 2013; 201:190-201. [PMID: 23789675 DOI: 10.2214/ajr.12.9507] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this review is to describe adrenal arterial anatomy and to discuss the indications, outcomes, and technical considerations of adrenal artery embolization. CONCLUSION Adrenal artery embolization can be used for management of adrenal tumors (palliative for pain relief, debulking, or hormone suppression) and treatment of acute bleeding from ruptured adrenal tumors, traumatic adrenal injury, and aneurysms. Variant arterial supplies, options for embolic agents, and potential complications are important considerations.
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Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg 2012; 36:75-82. [PMID: 22057755 DOI: 10.1007/s00268-011-1338-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Spontaneous adrenal hemorrhage associated with a mass is uncommon and treatment strategies are not standardized. Current treatment modalities range from supportive management and blood transfusion to embolization or immediate operative extirpation. Our objectives were to describe six cases from a single institution and to perform a literature review of the etiology of the condition and recommended management of patients with hemorrhagic adrenal masses. METHODS Records from six patients diagnosed with adrenal hemorrhage and an associated mass at a single institution were reviewed. Clinical records and outcomes were analyzed. A comprehensive review of 133 reported cases in the literature was performed. RESULTS Six patients presented with spontaneous adrenal hemorrhage that appeared to be associated with a mass, with tumor sizes ranging from 3.7 to 15 cm. Three patients underwent adrenalectomy for pheochromocytoma or adrenocortical cancer. Three patients did not undergo adrenalectomy: one had a metastasis from lung cancer, one underwent embolization, and one had resolution of the mass on interval imaging. A comprehensive review of the literature identified 133 cases, with pheochromocytoma the most commonly reported lesion (48%). CONCLUSIONS Spontaneous adrenal hemorrhage is rare. When it does occur, a high level of suspicion for malignant disease or pheochromocytoma should be maintained. The possibility of a hematoma masquerading as a neoplasm should also be considered. In cases of ongoing hemorrhage, embolization may be a lifesaving temporizing measure. Acute surgical intervention should be considered in selected patients, and surgery may not be required in all patients. A cautious approach with a comprehensive biochemical and imaging work-up is advised prior to operation.
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Sancho JJ, Triponez F, Montet X, Sitges-Serra A. Surgical management of adrenal metastases. Langenbecks Arch Surg 2011; 397:179-94. [DOI: 10.1007/s00423-011-0889-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
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Fatal retroperitoneal bleeding caused by metastasis of a sigmoid carcinoma. Case Rep Med 2011; 2011:373047. [PMID: 21860625 PMCID: PMC3157163 DOI: 10.1155/2011/373047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/10/2011] [Accepted: 06/29/2011] [Indexed: 11/17/2022] Open
Abstract
Retroperitoneal bleeding is relatively rare and a potentially life-threatening condition with significant mortality. Early recognition requires a high index of suspicion. Increased life expectancy, the widespread use of anticoagulants, and the rise of endovascular interventions have caused an increase in the incidence of retroperitoneal bleeding. We present a case of a 74-year-old woman who died because of retroperitoneal bleeding caused by retroperitoneal metastasis of a sigmoid carcinoma with angioinvasive growth into a lumbar artery. In addition we discuss etiology, diagnostic management, and treatment strategy.
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Ambika S, Melton A, Lee D, Hesketh PJ. Massive Retroperitoneal Adrenal Hemorrhage Secondary to Lung Cancer Metastasis Treated by Adrenal Artery Embolization. Clin Lung Cancer 2009; 10:E1-4. [DOI: 10.3816/clc.2009.n.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sahasrabudhe N, Byers R. Massive haemorrhagic adrenal metastases leading to sudden death: a case report. BMJ Case Rep 2009; 2009:bcr06.2008.0190. [PMID: 21686905 DOI: 10.1136/bcr.06.2008.0190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although adrenal glands are a common site of metastatic cancer, clinically significant haemorrhage into these is very uncommon with only a few cases having been previously published in the English literature. Here, a case of massive adrenal haemorrhage secondary to metastasis of lung cancer that led to the death of the patient is reported. To the best of our knowledge, such an acute death, without any prior medical attention or intervention, as a consequence of haemorrhagic adrenal metastasis has not been described before and is an important consideration in a person with lung cancer who dies unexpectedly.
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Affiliation(s)
- Neil Sahasrabudhe
- Royal Blackburn Hospital, Histopathology, Haslingden Road, Blackburn, BB23HH, UK
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Ahmad S, Abdulqawi R, Ashawesh K. Massive Retroperitoneal Adrenal Haemorrhage as the First Manifestation of a Lung Cancer. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n7p615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Khaled Ashawesh
- University Hospitals Coventry and Warwickshire NHS Trust, UK
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Oo TH, Martin L, Hesketh PJ. Adrenal hemorrhage secondary to metastasis from lung cancer. Clin Lung Cancer 2004; 4:183-5. [PMID: 14706168 DOI: 10.3816/clc.2002.n.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The adrenals are common metastatic sites for lung cancers as well as a number of other primary cancers. Usually these metastases are asymptomatic. Hemorrhagic adrenal metastases from lung cancer are extremely rare. Only 5 prior reports of hemorrhagic adrenal metastases from lung cancer have appeared in the English literature. We report a case of spontaneous, massive, adrenal hemorrhage secondary to metastatic lung cancer in a 62-year-old patient. In lung cancer, patients with sudden onset of pain in the flank or back in association with anemia and hypotension, adrenal hemorrhage secondary to metastatic disease should be considered in the differential diagnosis. Computed tomography scans and magnetic resonance imaging aid in confirming the diagnosis.
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Affiliation(s)
- Thein H Oo
- St. Elizabeth's Medical Center of Boston, Massachusetts 02135, USA
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Abstract
OBJECTIVE Adrenal metastases are frequently encountered during autopsy but uncommonly present clinically. The aim of this study was to evaluate the clinical and pathological impact of adrenal metastases in a large series of patients. PATIENTS Four hundred and sixty-four patients (288 men, 176 women) with metastatic disease in the adrenal glands over a 30-year period were included in the study. MEASUREMENTS The clinical records and pathological features were reviewed. RESULTS The frequencies of adrenal metastases at autopsies, adrenalectomies and fine-needle aspiration biopsies were 3.1%, 7.5% and 33%, respectively. The lesions were often seen in elderly patients (mean age, 62, SD = 13 years). Many of the metastatic lesions in the adrenal gland occurred shortly after the detection of a primary tumour (mean latent period = 7 months). Four per cent of the adrenal lesions (n = 20) were symptomatic. The symptomatic adrenal lesions, as compared with asymptomatic ones, were bigger and seen in younger patients. Five patients presented with adrenal insufficiency (Addison's disease) and one had massive peritoneal haemorrhage because of metastatic carcinoma. Ninety per cent (n = 421) of the metastatic adrenal tumours were carcinomas and 56% of these were adenocarcinoma. Lung was the most common primary tumour site (35%), followed by the stomach (14%), the oesophagus (12%) and the liver/bile ducts (10%). The adrenal metastases were bilateral in approximately half of the patients (49%, n = 229). The mean diameter of the adrenal metastases was 2 cm (SD = 1.9 cm). The mean weight of the right adrenal gland harbouring the metastasis was 19 g, while that of the left 20 g. The median survival of the 20 patients with symptomatic adrenal lesions was 3 months (range, 0-75 months) after the detection of adrenal metastases. Patients with surgically removed adrenal metastases had slightly better survival rates than those without surgical resection. CONCLUSIONS A variety of tumours may give rise to adrenal metastases. They are often asymptomatic and detected as part of multiorgan metastases. Symptomatic cases, albeit rare, may occur. Long-term survival may be achieved in selected patients in whom an aggressive surgical approach may be adopted.
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Affiliation(s)
- K-Y Lam
- School of Medicine, James Cook University, Townsville, Australia.
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Potti A, Schell DA. Unusual presentations of thoracic tumors: Case 1. Acute adrenal insufficiency due to metastatic lung cancer. J Clin Oncol 2001; 19:3780-2. [PMID: 11533102 DOI: 10.1200/jco.2001.19.17.3780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Potti
- Veterans Affairs Medical Center, Fargo, ND, USA
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Abstract
OBJECTIVE To characterize the clinical course of adrenal hemorrhage (AH) by using a systematic review of the presentation, associated conditions, and outcomes in patients with AH seen at our institution between 1972 and 1997 (a 25-year period). PATIENTS AND METHODS A computer search of recorded dismissal diagnoses identified 204 patients with a diagnosis of AH, but only 141 fulfilled our study criteria. Their records were analyzed systematically by presentation, bilateral or unilateral hemorrhage, corticosteroid treatment, and survival. RESULTS AH is a heterogeneous entity that occurs in the postoperative period, in the antiphospholipid-antibody syndrome, in heparin-associated thrombocytopenia, or in the setting of severe physical stress and multiorgan failure. Standard laboratory evaluation is not helpful in establishing the diagnosis. Of the 141 cases of AH, 78 were bilateral, and 63 were unilateral. Corticosteroid treatment in situations of severe stress or sepsis had little effect on outcome (9% vs. 6% survival with and without corticosteroid treatment, respectively). This is in sharp contrast to AH occurring postoperatively (100% vs. 17% survival with or without treatment, respectively) or in the antiphospholipid-antibody syndrome (73% vs. 0% survival, respectively). CONCLUSIONS A high index of suspicion is required to make a timely diagnosis of AH. Fever and hypotension in the appropriate clinical setting necessitate further investigation. Although the diagnosis of AH is infrequently made while the patient is alive, appropriate imaging techniques are useful for establishing a timely diagnosis. In severe physical stress or sepsis, AH may be a marker of severe, preterminal physiologic stress and poor outcome.
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Affiliation(s)
- A Vella
- Division of Endocrinology, Metabolism, Nutrition and Internal Medicine, Mayo Clinic, Rochester, Minn. 55905, USA.
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Kawashima A, Sandler CM, Ernst RD, Takahashi N, Roubidoux MA, Goldman SM, Fishman EK, Dunnick NR. Imaging of nontraumatic hemorrhage of the adrenal gland. Radiographics 1999; 19:949-63. [PMID: 10464802 DOI: 10.1148/radiographics.19.4.g99jl13949] [Citation(s) in RCA: 225] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nontraumatic hemorrhage of the adrenal gland is uncommon. The causes of such hemorrhage can be classified into five categories: (a) stress, (b) hemorrhagic diathesis or coagulopathy, (c) neonatal stress, (d) underlying adrenal tumors, and (e) idiopathic disease. Computed tomography (CT), ultrasonography (US), and magnetic resonance (MR) imaging play an important role in diagnosis and management. CT is the modality of choice for evaluation of adrenal hemorrhage in a patient with a history of stress or a hemorrhagic diathesis or coagulopathy (anticoagulant therapy). CT may yield the first clue to the diagnosis of adrenal insufficiency secondary to bilateral massive adrenal hemorrhage; such insufficiency is rare but life threatening. US is the modality of choice for evaluation of neonatal hematoma, and MR imaging is helpful for further characterization. MR imaging is also useful in the diagnosis of coexistent renal vein thrombosis. When an adrenal abscess is suspected, percutaneous aspiration and drainage under imaging guidance should be performed. Hemorrhage into an adrenal cyst or tumor can cause acute onset of symptoms and signs in a patient without discernible risk factors for adrenal hemorrhage. A hemorrhagic adrenal tumor should be suspected when CT or MR imaging reveals a hemorrhagic adrenal mass of heterogeneous attenuation or signal intensity that demonstrates enhancement.
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Affiliation(s)
- A Kawashima
- Department of Radiology, University of Texas-Houston Medical School, USA
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Berney CR, Roth AD, Allal A, Rohner A. Spontaneous retroperitoneal hemorrhage due to adrenal metastasis for non-small cell lung cancer treated by radiation therapy. Acta Oncol 1997; 36:91-3. [PMID: 9090978 DOI: 10.3109/02841869709100744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- C R Berney
- Digestive Surgery, Geneva University Hospital, Switzerland
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Ferrera PC, David SH, Bartfield JM. Spontaneous retroperitoneal hemorrhage presenting as asystolic arrest. Am J Emerg Med 1995; 13:107-10. [PMID: 7832933 DOI: 10.1016/0735-6757(95)90273-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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