肾上腺钝性损伤的CT分析

CT Findings of Acute Adrenal Injury after Blunt Abdominal Irauma

目的:探讨腹部钝性伤所致肾上腺损伤的CT征象。方法:回顾分析15例因腹部钝伤而行CT检查示有肾上腺损伤的资料,其中男性13例,女性2例。9例行CT平扫及增强检查,6例平扫;11例行CT随访。结果:15例肾上腺损伤均为单侧性损伤并伴同侧胸腹部损伤,位于右侧11例(73%),左侧4例,1例伴肾上腺肿瘤。10例CT主要表现为肾上腺区类圆形或卵圆形血肿(67%),3例(20%)表现为伤侧肾上腺增粗,1例(7%)表现为肾上腺区较弥漫的出血,1例原有肾上腺肿瘤存在。10例(67%)肾上腺邻近脂肪内出血呈条束状或局限性密度增高影,3例(20%)后肾周间隙的出血表现为类似膈脚增厚改变。结论:肾上腺损伤右侧远多于左侧,常伴有同侧胸腹腔和腹膜后损伤,肾上腺血肿有时需与肾上腺原发肿瘤相鉴别,鉴别主要方法是随访及增强CT检查。

Objective： To evaluate the CT signs of acute adrenal injury caused by blunt abdominal trauma. Methods： We retrospectively reviewed abdominal CT scans of 15 patients （13 of men,2 of women） with acute adrenal injury after blunt force trauma. 9 cases obtained nonenhanced and enhanced CT scans while 6 obtained nonenhanced CT scans, 11 cases had follow-up CT scans. Results： All these 15 adrenal injuries were unilateral and were accompanied by ipsilateral thoracic or/and abdominal injuries, 11 cases （73%） were right-sided and 4 （27%）cases were left-sided, in CT scans, 10 cases （67%） appeared as discrete round or oval masses expanding the adrenal gland,3 cases （20%） appeared as uniform swelling of the gland, 1 case （7%） appeared as diffuse irregular hemorrhage obliterating the gland, 1 case was accompanied by a preexisting adrenal tumor. Associated CT findings such as stranding of the periadrenal fat caused by blood （10 of 15.67%）, and posterior pararenal hemorrhage mimicking a thickened diaphragmatic crus （3 of 15.20%）. Conclusion： Adrenal injury caused by blunt trauma is more common in the right-sided, and is often accompanied by ipsilateral thoracic or/and abdominal injuries. The follow-up CT scan and contrast-enhanced CT scan are two effective ways of differential diagnosis between adrenal hemorrhage and adrenal tumor.