Non-Hemorrhagic Adrenal Infarction during Pregnancy: The Diagnostic Imaging Keys

• Published in: Tomography (Ann Arbor) Vol. 7; no. 4; pp. 533 - 544
• Main Authors: Chagué, Pierre, Marchi, Antoine, Fechner, Alix, Hindawi, Ghina, Tranchart, Hadrien, Carrara, Julie, Vivanti, Alexandre J, Rocher, Laurence
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 06.10.2021; MDPI AG
• Subjects: abdominal pain in pregnancy; Adrenal Gland Neoplasms; Adrenal Glands - diagnostic imaging; adrenal infarction; adrenal ischemia; adrenal thrombosis; Female; Humans; Infarction - diagnostic imaging; Magnetic Resonance Imaging - methods; MRI; non-hemorrhagic adrenal infarction; Pregnancy; Tomography, X-Ray Computed - methods; non-hemorrhagic adrenal infarction; MRI; management; adrenal thrombosis; adrenal ischemia; adrenal infarction; abdominal pain in pregnancy
• ISSN: 2379-139X; 2379-1381; 2379-139X
• DOI: 10.3390/tomography7040046

non-hemorrhagic adrenal infarction (NHAI) is a rare cause of acute abdominal/flank pain during pregnancy; in order to ensure prompt and appropriate treatment, this diagnosis should not be overlooked. This case series highlights pertinent imaging findings, including ultrasounds (USs), computed tomography (CT), and magnetic resonance imaging (MRI) of recent NHAI cases. we compiled all consecutive NHAI cases from two university hospitals over a two-year period and checked the relevant clinical, laboratory, and imaging findings. Relevant articles on NHAI published from January 2010 to March 2021 were analyzed. six cases were found in our database. CT-scans typically showed enlarged, hypodense, and non-enhanced adrenal glands. Unenhanced MRIs allowed for diagnoses and showed enlarged adrenal glands in the signal hyperintensity on T2 and diffusion-weighted imaging, without any signal hyperintensity on T1. In two of our six cases, USs showed swollen adrenal glands with fluid collection. NHAI and its differential diagnosis-in cases of acute pain during pregnancy-highlight the crucial roles of integrated radiological examination and cooperation between obstetricians and radiologists, both of whom should consider the location of the pain, the accessibility and tolerance of MRI, and the radiation exposure of CT. Despite its supposed poor sensitivity, an US performed because the patient reports pain should also be used to examine the adrenal gland regions. Non-enhanced MRI is clearly of value and access to it in emergencies is important to avoid radiation exposure.