E1084. Multimodality Imaging of Hemorrhagic Adrenals and Hemorrhagic Adrenal Lesions
  1. Sarah Pepley; University of Pittsburgh Medical Center
  2. Scott Beasley; University of Pittsburgh Medical Center
  3. Ka-Kei Ngan; University of Pittsburgh Medical Center
  4. Navya Dasyam; University of Pittsburgh Medical Center
  5. Varaha Tammisetti; University of Texas Health Science Center at Houston
  6. Venkata Katabathina; University of Texas Health Science Center at San Antonio
  7. Anil Dasyam; University of Pittsburgh Medical Center
The anatomy, histology, and physiology of adrenals with relevant aspects predisposing the glands to hemorrhage will be reviewed. Brief discussion regarding the clinical implications of adrenal hemorrhage will be discussed.

Educational Goals / Teaching Points
Discuss anatomy and endocrine functions of adrenal glands. Discuss short-term and long-term clinical implications of adrenal hemorrhage. Review etiologies of adrenal hemorrhage and their imaging appearances. Review neoplastic and nonneoplastic adrenal lesions with hemorrhage, and their imaging appearances. Review imaging mimics of adrenal hemorrhage and hemorrhagic adrenal lesions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The content of this presentation will begin with multimodality imaging appearances of normal adrenal glands. Next, pathophysiology, etiologies, and imaging appearances of spontaneous and provoked adrenal hemorrhage will be discussed including idiopathic, hypotension, sepsis, trivial trauma, major trauma, and iatrogenic (following adrenal venous sampling and upper abdominal surgeries). Following this, imaging spectrum of adrenal lesions with associated hemorrhage including adrenal pseudocyst, congenital cysts, adenoma, pheochromocytoma, adrenal myelolipoma, underlying vascular pathology (aneurysm/vasculitis), adrenal cortical carcinoma, and adrenal metastases will be reviewed. Finally, mimics of adrenal hemorrhage on imaging including adrenal infarction, complex cystic and necrotic neoplasms, adenoma with internal degeneration, and metastasis from melanoma will be explored.

Adrenal hemorrhage is a potentially life-threatening entity that encompasses a wide range of etiologies. Certain pre-existing adrenal lesions may also undergo hemorrhage. Building a thorough differential diagnosis with the ability to discern the salient features of each lesion can guide the treatment strategy of clinicians and even prevent unnecessary interventions.