1/8. Adrenal hemorrhage: a 25-year experience at the Mayo Clinic.OBJECTIVE: To characterize the clinical course of adrenal hemorrhage (AH) by using a systematic review of the presentation, associated conditions, and outcomes in patients with AH seen at our institution between 1972 and 1997 (a 25-year period). patients AND methods: A computer search of recorded dismissal diagnoses identified 204 patients with a diagnosis of AH, but only 141 fulfilled our study criteria. Their records were analyzed systematically by presentation, bilateral or unilateral hemorrhage, corticosteroid treatment, and survival. RESULTS: AH is a heterogeneous entity that occurs in the postoperative period, in the antiphospholipid-antibody syndrome, in heparin-associated thrombocytopenia, or in the setting of severe physical stress and multiorgan failure. Standard laboratory evaluation is not helpful in establishing the diagnosis. Of the 141 cases of AH, 78 were bilateral, and 63 were unilateral. Corticosteroid treatment in situations of severe stress or sepsis had little effect on outcome (9% vs. 6% survival with and without corticosteroid treatment, respectively). This is in sharp contrast to AH occurring postoperatively (100% vs. 17% survival with or without treatment, respectively) or in the antiphospholipid-antibody syndrome (73% vs. 0% survival, respectively). CONCLUSIONS: A high index of suspicion is required to make a timely diagnosis of AH. fever and hypotension in the appropriate clinical setting necessitate further investigation. Although the diagnosis of AH is infrequently made while the patient is alive, appropriate imaging techniques are useful for establishing a timely diagnosis. In severe physical stress or sepsis, AH may be a marker of severe, preterminal physiologic stress and poor outcome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Cystic neuroblastoma.In the newborn, cystic masses of the adrenal gland are unusual findings and most are secondary to hemorrhage. We present a patient with a clinical history typical for adrenal hemorrhage who was found to have a thick walled cystic adrenal mass on both physical and ultrasound examination. During evaluation the mass decreased in size, but vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels were elevated. laparotomy and left adrenalectomy confirmed the diagnosis of a cystic neuroblastoma. Adrenal cyst, adrenal abscess, and cystic neuroblastoma are all rare entities in the newborn. We recommend that all cystic masses of the adrenal be evaluated by urinary VMA and HVA and that the possibility of cystic neuroblastoma be kept in mind when an adrenal cystic mass is followed nonoperatively.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/8. Spontaneous retroperitoneal hemorrhage localized by blood pool scintigraphy.A healthy 17-year-old girl presented to the emergency department with a 1-day history of left upper quadrant abdominal pain associated with nausea and vomiting. Her hematocrit was 22. On physical examination, she had left upper quadrant fullness and tenderness. Initial computed tomography revealed a large, loculated, left-sided retroperitoneal hematoma. blood pool scintigraphy with labeled red cells revealed a very large photon-deficient area with 3 areas of active bleeding in the upper margin of the cold area. An angiogram showed active extravasation from the left inferior phrenic artery. The patient was felt to have had spontaneous adrenal hemorrhage, likely within a preexisting, large adrenal cyst. Spontaneous hemorrhage into an adrenal cyst is a rare entity that can be life-threatening if not treated early in its course.- - - - - - - - - - ranking = 7.3131082996212keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Adrenal haemorrhage presenting as an abdominal mass in the newborn.Adrenal haemorrhage in the newborn, an entity well recognized at autopsy and as a cause of massive haemorrhage, may present as an asymptomatic abdominal mass. Three cases of neonatal adrenal haemorrhage are described and the literature is reviewed. Most of the affected babies were of normal birthweight, full term and with no history of difficult delivery or neonatal asphyxia. Most presented with a flank mass and jaundice. The haemoglobin was not always low. Intravenous urography and sonography were the investigations of choice. The most serious condition in the differential diagnosis is neuroblastoma, but the chance of this presenting in the newborn period with normal catecholamine secretion and no evident metastases is sufficiently rare to justify expectant management. Follow-up physical examination and repeat sonography at 1 month are recommended. This interval is long enough to allow resolution of a mass caused by adrenal haemorrhage.- - - - - - - - - - ranking = 7.3131082996212keywords = physical examination, physical (Clic here for more details about this article) |
5/8. anticoagulants and abdominal pain. The role of computed tomography.The development of abdominal pain in the patient receiving anticoagulants, especially with a documented drop in hematocrit levels, almost certainly indicates a major hemorrhage. If loss of blood from the GI tract is not documented, some form of internal bleeding must have occurred. Unfortunately, the site of the bleeding is frequently unclear. Even small hemorrhages in critical locations (eg, the adrenal gland) can have serious consequences. In the obese patient, a rectus sheath hematoma may remain hidden at the time of repeated physical examinations. Generally, the cause of a mass palpated or perhaps demonstrated by conventional radiological studies cannot be diagnosed accurately. Computed tomography can demonstrate the size and location of the mass and its relation to normal intra-abdominal structures. By careful evaluation of the attenuation coefficient, it is possible to establish the definitive diagnosis of hemorrhage. Should the attenuation value of a mass be insufficiently high to diagnose hemorrhage conclusively on the initial scan, serial scans demonstrating a decrease in size and/or attenuation of the mass confirm the diagnosis of hemorrhage. In our opinion a negative CT examination is a reliable indicator that such a bleeding complication has not occurred.- - - - - - - - - - ranking = 7.3131082996212keywords = physical examination, physical (Clic here for more details about this article) |
6/8. Prenatal sonographic diagnosis of fetal adrenal gland hemorrhage.BACKGROUND: In newborn the finding of adrenal gland hemorrhage is not uncommon. Only few cases of prenatal diagnosis of fetal adrenal bleeding by sonography have been reported. CASE: In a 28-year-old nulliparous pregnant woman, routine sonography performed in 35 2 weeks of gestational age showed a cystic mass on the upper pole of the right kidney of a male fetus with normal biophysical profile and Doppler flow indices. Sonographic examination demonstrated a spontaneous remission within 3 weeks after uncomplicated vaginal delivery. CONCLUSION: In the management of adrenal gland hemorrhage of the fetus or newborn, control of remission by sonography is a sufficient tool for differentiation against other tumors and is helpful in preventing unintended surgical removal of the adrenal gland.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/8. A large adrenal pseudocyst mimicking malignant intraabdominal tumor: a case report.An abdominal mass was found in an apparently healthy 66-year-old man during he was undergoing a routine physical check-up. Intravenous pyelography showed a huge suprarenal cyst displacing the left kidney. Both kidneys had normal renal function. The tumor was removed transperitoneally. It contained 1600 ml hemorrhagic fluid and had small golden nodules on the inner cystic surface. Microscopically, adrenal cortical tissue was present in groups or scattered along the cystic wall, which was compatible with the diagnosis of pseudocyst. No lining epithelium was present. The differential diagnosis, pathogenesis, management, and the general features of adrenal pseudocysts were discussed.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/8. Management of adrenal cysts.Adrenal cysts have been traditionally managed by excision to rule out malignancy. We reviewed the 613 cases of adrenal cysts (including 6 new cases of our own) to evaluate whether this is still appropriate. Descriptive statistics and distribution of each pathologic type have been updated, based on 515 cases, and have changed from statistics compiled on 155 cases by G. A. Absehouse et al. Only seven per cent of all adrenal cysts are malignant or potentially malignant. There is only one reported case of a malignancy found in a nonfunctioning adrenal cyst that was initially thought to be benign. In this case, no CT or aspiration was performed. There have been 19 cases of adrenal cysts managed with aspiration. All were nonfunctioning and benign. One had a bloody aspirate. Reaccumulation occurred in 32 per cent of the cases (six cases); six per cent were symptomatic, four per cent were excised. Follow up was available in 15 cases from 4 months to 3.5 years. Management of the patient with a suspected adrenal cyst should include a careful history and physical and biochemical screening to rule out a functioning lesion. A CT scan, and aspiration of the cyst with a cystogram should be performed to confirm a simple cyst of the adrenal. If the suspicion of malignancy is low, and the lesion is nonfunctional, the adrenal cyst may be managed by aspiration alone. If the cyst recurs and is asymptomatic, it may be observed. If a symptomatic cyst recurs, it may be reaspirated or excised.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |