TY - JOUR
T1 - Adrenal hemorrhage in abused children
T2 - Imaging and postmortem findings
AU - Nimkin, K.
AU - Teeger, S.
AU - Wallach, M. T.
AU - DuVally, J. C.
AU - Spevak, M. R.
AU - Kleinman, P. K.
PY - 1994
Y1 - 1994
N2 - OBJECTIVE. Adrenal hemorrhage associated with child abuse has received little attention in published reports. We review imaging studies or pathologic findings of adrenal hemorrhage in five cases of proved child abuse. SUBJECTS AND METHODS. The imaging findings in three children with adrenal hemorrhage were analyzed retrospectively. All three had abdominal CT scans and skeletal radiographs. One also had abdominal sonograms and MR images. The pathologic findings in two other abused children with adrenal hemorrhage who died of head injuries were also studied. In all five cases, a history of trauma was not initially known; child abuse was later confirmed. RESULTS. Unilateral hemorrhage in the right adrenal gland was found in all patients. Enhanced CT scans of the abdomen showed a low-attenuation, oval mass separating the limbs of the adrenal gland. Sonograms in one case showed a small, heterogeneous mass in the right adrenal gland. MR images obtained 3 weeks later showed an area of high signal intensity within the right adrenal gland on both T1- and T2-weighted images, consistent with subacute hemorrhage. In both deceased children, autopsy showed hemorrhage in the right adrenal gland, mainly within the medulla with some extension beyond the capsule in one case. All five children had associated abdominal visceral injuries or rib fractures or both, on the same side as the hemorrhage. CONCLUSION. Imaging findings of adrenal hemorrhage are similar to those previously described in patients with accidental trauma. Pathologic sections of the gland reveal predominantly medullary involvement with hemorrhage. The presence of adrenal hemorrhage in a child should prompt a search for other associated injuries and raise the possibility of unsuspected trauma.
AB - OBJECTIVE. Adrenal hemorrhage associated with child abuse has received little attention in published reports. We review imaging studies or pathologic findings of adrenal hemorrhage in five cases of proved child abuse. SUBJECTS AND METHODS. The imaging findings in three children with adrenal hemorrhage were analyzed retrospectively. All three had abdominal CT scans and skeletal radiographs. One also had abdominal sonograms and MR images. The pathologic findings in two other abused children with adrenal hemorrhage who died of head injuries were also studied. In all five cases, a history of trauma was not initially known; child abuse was later confirmed. RESULTS. Unilateral hemorrhage in the right adrenal gland was found in all patients. Enhanced CT scans of the abdomen showed a low-attenuation, oval mass separating the limbs of the adrenal gland. Sonograms in one case showed a small, heterogeneous mass in the right adrenal gland. MR images obtained 3 weeks later showed an area of high signal intensity within the right adrenal gland on both T1- and T2-weighted images, consistent with subacute hemorrhage. In both deceased children, autopsy showed hemorrhage in the right adrenal gland, mainly within the medulla with some extension beyond the capsule in one case. All five children had associated abdominal visceral injuries or rib fractures or both, on the same side as the hemorrhage. CONCLUSION. Imaging findings of adrenal hemorrhage are similar to those previously described in patients with accidental trauma. Pathologic sections of the gland reveal predominantly medullary involvement with hemorrhage. The presence of adrenal hemorrhage in a child should prompt a search for other associated injuries and raise the possibility of unsuspected trauma.
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U2 - 10.2214/ajr.162.3.8109518
DO - 10.2214/ajr.162.3.8109518
M3 - Article
C2 - 8109518
AN - SCOPUS:0028215020
SN - 0361-803X
VL - 162
SP - 661
EP - 663
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 3
ER -