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Objective: Hemorrhage into an existing adrenal nodule may increase nodule size and produce radiographic changes associated with malignancy. This study focuses on identifying incidental adrenal hemorrhages, and defining imaging features that distinguish them from malignancies.
Design: Retrospective case series.
Setting: Tertiary care institution.
Patients: 40 non-trauma patients with non-functioning adrenal neoplasms. Mean patient age was 61 ± 14. There were 17 males and 23 females.
Intervention: Radiology and pathology databases were queried for the terms “adrenal hemorrhage” and “hematoma.” Imaging studies were blindly reviewed and scored by a radiologist for high or low likelihood of hemorrhage.
Main Outcome Measures: Clinical courses and pathologic diagnoses were assessed to validate the radiographic impression.
Results: Diagnosis of the adrenal abnormality was incidental in 90%. Mean maximum lesion diameter was 3.7 ± 1.8 cm. 10 patients underwent adrenalectomy and had pathology consistent with adrenal hemorrhage. The following CT findings were present in the patients with pathologic confirmation of hemorrhage. Margins were smooth in 87.5%. Calcifications were present in 14.3%. Density was homogeneous in 57.1%. Contrast enhancement was present in 83.3%. The average Hounsfield Unit density was 31 ± 18.5. Size, margins, presence of calcifications, and Hounsfield Unit density did not significantly differ between the two groups. In the high probability group, 75% of lesions appeared homogeneous compared to 33.3% in the low probability group. In high probability scans, contrast enhancement was present in 25%, compared to 85.7% in the low probability group.
Conclusions: Hemorrhage into non-functioning adrenal incidentalomas is associated with homogenous density and lack of contrast enhancement. Defining such criteria may aide accurate diagnosis and spare some patients a diagnostic adrenalectomy.