A 75-year-old man on anticoagulant treatment presents with easily bleeding gums and abdominal discomfort.

Fig. 73.1 Noncontrast axial CT image through the left adrenal gland shows a rounded left adrenal mass (arrow) that is hyperdense on CT with a density of 55 to 60 HU.

Adrenal hemorrhage

• Hemorrhage within an adrenal neoplasm or cyst
  
• Neuroblastoma

Adrenal hemorrhage is a rare condition that usually occurs in response to stressful stimuli, such as infection, septicemia, blunt abdominal trauma, hypotensive shock, burns, neonatal asphyxia, coagulopathies with different causes, and inferior vena caval or renal venous thrombosis. Unilateral right adrenal involvement is most common.

Neonates with a history of asphyxia and/or septicemia can present with an abdominal mass, hypotension, hemodynamic shock, anemia, and jaundice and, rarely, with scrotal hematoma. In adults with coagulopathies, blunt trauma, and septicemia, adrenal hemorrhage is detected as an incidental finding on a work-up for internal concealed bleeds.