부신 출혈, 동맥 색전술

51세/ 여자

Adrenal hemorrhage

A 51-year-old woman was brought to the emergency department by hypovolemic shock. The patient was stablized after embolization of the adrenal artery. No adrenal insufficiency or other complications were noted.

Abdominal and pelvic CT scan show ed a large retroperitoneal hematoma extending from the right upper quadrant to the pelv is(Fig.1 a-b). The abdominal aortography appeared normal. Active bleeding w as confirmed by leakage of contrast media from the adrenal gland on selective angiography of the right inferior phrenic artery (Fig 2-a).

The right inferior phrenic artery and two adrenal branches were embolized with microcoils(3mm to 2mm(n=5)), 4mm to 2 mm(n=5), 5 mm to 2 mm(n=3))(VortX, Target Therapeutics Inc., USA)(Fig 2-b). The inferior adrenal artery originated from the right renal artery was intact.

a,b. A large retroperitoneal hematoma extending from the right upper quadrant to the pelvis is shown.A

a. A leakage of contrast media from the adrenal gland on selective angiography of the right inferior phrenic artery is shown. b. The right inferior phrenic artery and its adrenal branches are embolized with microcoils.

Adrenal hemorrhage is a rare condition in adults, occurring in association with trauma, severe physical stress, surgery, anticoagulation therapy, septicemia, hypotension or tumor (pheochromocytoma, metastases, carcinoma or adenoma). Vella Adrian et al. proposed a mechanism of the susceptability of adrenal gland to massive intraglandular bleeding which is probably related to the complex vascular supply. Although high resolution CT scan or MRI is sensitive for investigation of retroperitoneal hemorrhage, adrenal hemorrhage could be overlooked in the presence of massive retroperitoneal hemorrhage. As seen in this case, even thoracic or abdominal aortography may not reveal the bleeding from the small distal branches which supply thermal organs or tissue. Therefore careful investigation of each systemic arterial branches is required. Selective angiography of adrenal gland should be included in evaluation of massive retroperitoneal hemorrhage by unknown origin. Furthermore the bleeding can be successfully treated by transarterial embolization.

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