Imaging Pearls ❯ Adrenal ❯ Shock
|
-- OR -- |
|
- "Hypovolemic shock may be seen in trauma patients, and reduced blood volume typically prompts increased sympa- thetic activity, which can cause a constellation of findings on CT imaging, also known as the CT hypoperfusion complex. Hyperenhancing mesenteric vessels, decreased aortic caliber, slit-like IVC, intense enhancement of the kidneys, and dilated fluid-filled bowel loops are the findings of this complex . On imaging, shock adrenal glands demonstrate marked enhancement with preserved contours. Persistent, intense adrenal enhancement may be a sign of shock that precedes other imaging features of hypoperfusion, and similar findings were also observed in patients with severe acute pancreatitis.”
Cross‐sectional imaging features of unusual adrenal lesions: a radiopathological correlation
Karaosmanoglu AD et al.
Abdominal Radiology (2021) 46:3974–3994
- "Hypovolemic shock may be seen in trauma patients, and reduced blood volume typically prompts increased sympathetic activity, which can cause a constellation of findings on CT imaging, also known as the CT hypoperfusion complex . Hyperenhancing mesenteric vessels, decreased aortic caliber, slit-like IVC, intense enhancement of the kidneys, and dilated fluid-filled bowel loops are the findings of this complex. On imaging, shock adrenal glands demonstrate marked enhancement with preserved contours. Persistent, intense adrenal enhancement may be a sign of shock that precedes other imaging features of hypoperfusion, and similar findings were also observed in patients with severe acute pancreatitis.”
Cross‐sectional imaging features of unusual adrenal lesions: a radiopathological correlation
Ali Devrim Karaosmanoglu et al.
Abdominal Radiology (2021) 46:3974–3994 - "Addison disease (AD), which refers to adrenal insuffi- ciency caused by a severe deficiency of glucocorticosteroids and mineral corticosteroids, may be potentially fatal. Although the most common cause of AD worldwide is tuberculosis, the primary autoimmune process is the predominant etiology in the developed countries. The diagnosis is difficult and clinical, as the symptoms may be extremely non-specific and insidious, and almost half of the patients are first diagnosed with acute adrenal crisis. Other rare causes of adrenal insufficiency are fungal infections, tuberculosis, hemorrhage, and acquired immunodeficiency syndrome.”
Cross‐sectional imaging features of unusual adrenal lesions: a radiopathological correlation
Ali Devrim Karaosmanoglu et al.
Abdominal Radiology (2021) 46:3974–3994
- "Adrenal infarction is a rare cause of adrenal insufficiency and can be hemorrhagic or non-hemorrhagic, the latter being less common. Most reports have been described in patients with primary antiphospholipid-antibody syndrome (PAPS) and less commonly in pregnancy, heparin- induced thrombocytopenia, myelodysplastic syndrome and Crohn’s disease. Up to 36% of patients with PAPS present with adrenal insufficiency as the first manifestation of the disease.”
CT and MR imaging of acute adrenal disorders
Amar Udare et al.
Abdominal Radiology https://doi.org/10.1007/s00261-020-02580-w - "On CT, the infarcted adrenals are seen as enlarged hypodense glands with absent or poor contrast enhancement. Moschetta et al. described the capsular rim sign in 83% of patients with adrenal infarction, seen as diffusely enlarged hypodense gland with a thin rim of peripheral enhancement, likely due to residual perfusion of the adrenal capsular veins.”
CT and MR imaging of acute adrenal disorders
Amar Udare et al.
Abdominal Radiology https://doi.org/10.1007/s00261-020-02580-w
- “ Finally, it is important to recognize intense adrenal enhancement in morphologically normal-shaped adrenals, especially in unwell patients, because this finding may be an early sign of impending shock, warranting early critical-care management, and may also be a marker of poor prognosis in ill patients.”
Intense Adrenal Enhancement: A Feature of Hypoperfusion Complex
Venkatanarasimha N, Roobottom C
American Journal of Roentgenology. 2010;195: W82-W82 - “We propose that adrenal enhancement may be a sign of hyperperfusion in early stage of shock due to the crucial role of the adrenal glands in this clinical situation. This may not persist with further circulatory compromise due to vasoconstriction. If confirmed, its recognition has potential value of identifying a therapeutic window before irreversible shock set in.”
Persistent adrenal enhancement may be the earliest CT sign of significant hypovolaemic shock.
Cheung SC et al.
Clin Radiol 2003 April 58(4):315-318
- “Intense adrenal gland enhancement is defined as attenuation values equal or greater than those of the IVC . This is symmetrical in the majority of cases. The aetiology of intense adrenal gland enhancement is not known; however, it is likely to be related to a sympathetic response to hypovolaemic shock, along with preservation of perfusion to the adrenal glands as a vital organ. Although useful, intense enhancement of the adrenal gland is not unique to the hypovolaemic shock complex.”
A Pictorial Review of Hypovolaemic Shock in Adults
Tarrant AM et al.
British J Radiol 81(2008), 252-257 - “The aetiology of intense adrenal
gland enhancement is not known; however, it is likely to be related to a sympathetic response to hypovolaemic shock, along with preservation of perfusion to the adrenal glands as a vital organ. Although useful, intense enhancement of the adrenal gland is not unique to the hypovolaemic shock complex. The authors have observed this sign in other situations, e.g. following severe burns or surgery.”
A Pictorial Review of Hypovolaemic Shock in Adults
Tarrant AM et al.
British J Radiol 81(2008), 252-257 - “In 1987, Taylor et al described the CT findings of hypoperfusion in three children with hypovolaemic shock. The CT signs described included diffuse dilatation of the intestine with fluid; abnormal intense contrast enhancement of the bowel wall, mesentery, kidneys and pancreas; decreased calibre of the abdominal aorta and inferior vena cava (IVC); and a moderate to large volume of free peritoneal fluid.”
A Pictorial Review of Hypovolaemic Shock in Adults
Tarrant AM et al.
British J Radiol 81(2008), 252-257