Imaging of nontraumatic hemorrhage of the adrenal gland
Imaging of nontraumatic hemorrhage of the adrenal gland
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DOI：
10.1148/radiographics.19.4.g99jl13949
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发表时间：
1999-07-01
期刊：
影响因子：
5.5
通讯作者：
Dunnick, NR
中科院分区：
文献类型：
--
作者：
Kawashima, A;Sandler, CM;Dunnick, NR
肾上腺非外伤性出血并不常见。这种出血的原因可分为五类：(a)应激，(b)出血性或凝血功能障碍，(c)新生儿应激，(d)潜在的肾上腺肿瘤，(e)特发性疾病。计算机断层扫描（CT）、超声成像（US）和磁共振成像（MR）在诊断和治疗中发挥着重要作用。对于有应激史或出血性或凝血功能障碍（抗凝治疗）的患者，CT是评估肾上腺出血的首选方式，CT可能为诊断双侧大量肾上腺出血继发肾上腺功能不全提供第一线索；这种机能不足很少见，但会危及生命。超声是评估新生儿血肿的首选方式，磁共振成像有助于进一步表征。磁共振成像对并发肾静脉血栓的诊断也很有用。当怀疑肾上腺脓肿时，应在影像学指导下经皮穿刺引流。肾上腺囊肿或肿瘤出血可引起急性发作的症状和体征，而没有明显的肾上腺出血危险因素。当CT或MR成像显示出血性肾上腺肿块不均匀衰减或信号增强时，应怀疑肾上腺出血性肿瘤。
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 6 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.