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Choi, Kim, Ryu, Kim, and Choi: MDCT Findings of Traumatic Adrenal Injury in Children
Pediatric Radiology
Original Article

Journal of the Korean Society of Radiology 2011; 64(2): 191-195.

Published online: 28 February 2011

DOI: https://doi.org/10.3348/jksr.2011.64.2.191

MDCT Findings of Traumatic Adrenal Injury in Children

Seung Joon Choi, M.D., Jee-Eun Kim, M.D., Il Ryu, M.D.2, Jin Joo Kim, M.D.3, Hye-Young Choi, M.D.

1Department of Radiology, Gachon University, Gil Medical Center, Incheon, Korea.

2Department of Pediatrics, Gachon University, Gil Medical Center, Incheon, Korea.

3Department of Emergency Medicine, Gachon University, Gil Medical Center, Incheon, Korea.

Address reprint requests to: Jee-Eun Kim, M.D., Department of Radiology, Gachon University of Medicine and Science, Gil Medical Center, 1198 Kuwol-dong, Namdong-gu, Incheon 405-220, Korea. Tel. 82-32-460-3060, Fax. 82-32-460-3065, boram107@gilhospital.com

Received 5 June 2010       Accepted 8 November 2010

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

We wanted to evaluate the MDCT findings and concomitant injuries of traumatic adrenal injury in children.

Materials and Methods

Among 375 children who had undergone a MDCT scan for abdominal trauma during the recent five years at our institution, 27 children who had revealed adrenal injury on their CT scan were included in the study. We retrospectively evaluated the causes of the trauma, the patterns of adrenal injury, the associated CT findings and the concomitant injuries of the other organs in the abdomen.

Results

We identified 27 children (7.5%) (17 boys and 10 girls, mean age: 9.9 years, range: 2-18 years) with adrenal injury. The causes of adrenal injury were a traffic accident for 20 patients (74%), falls for four patients (15%) and blunt trauma for three patients (11%). The right adrenal gland was injured in 20 patients (74%), while the left adrenal gland was injured in three patients and bilateral involvement was noted in four patients. The patterns of adrenal injury were round or oval shaped hematoma in 23 lesions (74%), irregular hemorrhage with obliterating the gland in six lesions (19%) and active extravasation of contrast material from the adrenal region in two lesions (7%). Concomitant injuries were noted in 22 patients (81%), including 15 patients with liver laceration (56%), 11 patients with lung contusion (41%) and nine patients with renal injury (33%).

Conclusion

The frequency of adrenal injury was 7.5%. The right adrenal gland was more frequently involved. Concomitant organ injury was noted 81% of the patients and the most frequently involved organ was the liver (56%).

Keywords: Child, Multiple Trauma, Adrenal Glands Diseases, Tomography, X-Ray Computed

Figures and Tables

Fig. 1

A 7-year-old boy with right adrenal injury caused by blunt trauma.

A. Post contrast axial image shows an ovoid shaped right adrenal hematoma with periadrenal fat stranding (arrow). The image also shows concomitant injury of laceration in caudate lobe of the liver (arrowhead).
B. After 2 months, follow up post contrast axial image demonstrates decreased size of right adrenal hematoma (arrow) and disappeared liver laceration in the caudate lobe.
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Fig. 2

An 11-year-old boy with right adrenal injury caused by fall down.

Post contrast axial image shows an irregular shaped right adrenal hematoma with periadrenal fat stranding (arrow).
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Fig. 3

A 14-year-old boy with right adrenal injury caused by blunt trauma. Post contrast axial image shows extravasated right adrenal hemorrhage.

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Fig. 4

A 9-year-old boy with right adrenal injury caused by traffic accident.

A. Post contrast axial image shows suspicious low attenuated lesion around right adrenal gland (arrow).
B. Reformatted coronal image reveals small amount of right adrenal hematoma (arrow).
jksr-64-191-g004
Table 1

Associated and Concomitant Injury

jksr-64-191-i001

Note.─ †: percentage calculated by dividing the number of patients in the study group of by the total number of patient with adrenal injury

Table 2

ISS* and Duration of Admission

jksr-64-191-i002

Note.─ ISS* : injury severity scoring

† isolated: adrenal injury without concomitant other organ injury

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