Unilateral adrenal hemorrhage is unusual and usually is related to a unilateral adrenal mass or trauma. In one series, adrenal hematoma was detected in 1.9% of 2692 trauma patients who underwent computed tomography (CT). Compared with the other trauma patients, the patients with adrenal hematomas had more severe injuries associated with higher mortality. Herein we present a case of a patient with unilateral adrenal hemorrhage caused by blunt force trauma.
Four weeks before coming to Mayo Clinic, this 61-year-old man was using a four-wheel all-terrain vehicle on a hunting trip. He had a rollover accident and landed on his chest and sustained four right-sided rib fractures. Most of his pain was localized to his right posterior flank. In the emergency department a CT with contrast was performed of his head, chest, and abdomen. Nondisplaced fractures of the right fifth, sixth, seventh, and eighth ribs were noted. In addition, a 4.5 × 2.7 cm right adrenal mass was found ( Fig. 67.1 ). It took about 4 weeks for the right flank pain to resolve. He had no paroxysmal symptoms and there was no history of hypertension. His weight had been stable. The patient had no signs or symptoms of Cushing syndrome. There was no history of hypokalemia. He had no prior abdominal cross-sectional computed imaging studies. The patient took no regular medications. On physical examination his body mass index was 28.2 kg/m 2 , blood pressure 110/72 mmHg, and heart rate 65 beats per minute. He had no stigmata of an adrenal disorder. Heart and lung examinations were normal.
The laboratory studies were normal ( Table 67.1 ). There was no clinical or biochemical evidence of adrenal gland dysfunction.