銅筋鐵肋的秘密基地

woman passenger in motorcycle collision
Is there's anything wrong in this CT?

A. spleen
B. liver
C. pancreas
D. adrenal
E. none of above

====================================================================

Dx: Rt adrenal hemorrhage

影像學: enlarged adrenal gland, 有時可在周圍發現出血的hyperdense lesion

Other nontraumatic (often bilateral) causes include.

• Iatrogenic (anticoagulation therapy) -> most common cause of bilateral adrenal hemorrhage.
• Metastases (lung cancer or malignant melanoma).
• Stress (surgery, burns, sepsis, hypotension, steroids).
• Meningococcal septicemia (Waterhouse-Friderichsen syndrome).
• Pheochromocytoma.
• Antiphospholipid antibody syndrome & DIC.
• Idiopathic.

Right-sided hemorrhage much more common, R:L 9:1, bilateral in 20% of cases Bilateral adrenal hemorrhage in 15% of patients who die of shock. Usually up to 90% of adrenal tissue is destroyed before patients manifest symptoms of adrenal insufficiency.

重點: 所以這樣的病人要小心adrenal insufficiency導致的shock-->expire!